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Reiner Labitzke, Manual of Cable Osteosyntheses Reiner Labitzke, Manual of Cable Osteosyntheses Springer-Verlag Berlin Heidelberg GmbH Reiner Labitzke Manual of Cable Osteosyntheses History, Technical Basis, Biomechanics of the Tension Band Principle, and Instructions for Operation With contributions by A.J. Weiland, New York, K.-P. Schmit-Neuerburg, Essen Frei Otto, Stuttgart, A. Richter, Darmstadt D.M. DaU, Hermanus, SA, and A. Miles, Bath, UK With 156 Figures in 400 Parts Springer Univ.-Prof. Dr. med. habil. Reiner Labitzke Chair of Surgery of Private University of Witten/Herdecke Director of the Clinic for general surgery and traumatology of UWH at Evangeli­ sches Krankenhaus, D-58239 Schwerte, Germany Studies ofhuman medicine at Humboldt-University and Free University Berlin and University of Vienna. Specialist for visceral surgery and traumatology. Fields of sci­ entific work in traumatology: Biomechanics; Development of methods of operations and implants, e.g. elastic rib clamps for the flail-chest stabilisation (1976); the cable osteosynthesis system (1978) for tension bandings and related operations; the Endo­ Helix (1989), an atraumatic screwed-in intramedullary stabilisator for biologica! osteosyntheses of humerus and childlike fractures of tubular bones. ISBN 978-3-642-63059-0 Cataloging-in-Publication Data applied for Die Deutsche Bibliothek - CIP-Einheitsaufnahme Labitzke, Reiner : Manual of cable osteosyntheses / R. Labitzke. - Berlin; Heidelberg ; New York; Barcelona ; Hong Kong ; London ; Milan ; Paris; Singapore; Tokyo: Springer, 2000 ISBN 978-3-642-63059-0 ISBN 978-3-642-57167-1 (eBook) DOI 10.1007/978-3-642-57167-1 This work is subject ta copyright. AII rights are reserved, whether the whole ar part of the material is concerned, specifically the rights of translation, reprinting, reuse of illus­ trations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Viola­ tions are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 2000 Originally published by Springer-Verlag Berlin Heidelberg New York in 2000 Softcover reprint of the hardcover lst edition 2000 The use of general descriptive names, registered names, trademarks, etc. in this publi­ cation does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book. In every individual case the user must check such information by consulting the rele­ vant literature. Cover design: E. Kirchner, D-69121 Heidelberg Typesetting: FotoSatz Pfeifer GmbH, D-82166 Grăfelfing Printed on acid-free paper - SPIN: 10718532 24/3135 - 5 4 3210 This book is dedicated to all those who step by step helped in the creation, development and application of cables with their imagination, vision and drive and who in many cases have remained anonymous, as well as to Netti, Tini, Nina and Niki Foreword Professor Reiner Labitzke has authored a manual which focuses on the applica­ tion of cable osteosyntheses. This technique is an integral part of the orthopae­ dic and trauma surgeon's armamentarium for the treatment of fractures and non-unions. The manual describes osteosynthesis techniques which can be performed with cables after an introduction which includes a brief history of wires and ca­ bles in medicine. Biomechanical data comparing tensile strengths, cerclage wire and wire cables provide a scientific basis for the use of this technique. The main section of the text describes the application of cables in the treat­ ment of patella and olecranon fractures, in addition to its use in ankle joint and pilon fractures. This technique has also been used by the authors for the treat­ ment of acetabular fractures and in performing osteotomies at the knee level. The manual is well illustrated and contains explanatory illustrations and photographs for each of the techniques described. For orthopaedists and trau­ ma surgeons not familiar with the many applications of cable osteosyntheses, this text will be a welcome addition to their library. Andrew]. Weiland, MD, Professor of Orthopaedic and Plastic Surgery at Cornell University Medical College, Attending Orthopaedic Surgeon, Hospital for Special Surgery, New York, NY, USA Foreword- Reiner Labitzke had completed his surgical training at the time he applied for the vacant position of a senior registrar at the Department of Trauma Surgery in March 1976, 1 year after I had been elected chairman of the Traumatology De­ partment and Director of the University Clinic in Essen. Being an "AO clinic" we followed strictly the AO philosophy with regard to clinical application of the newly developed operative methods for fracture fixation as well as to basic re­ search and scientific analysis of fracture healing and bone remodeling under modified biomechanical conditions. While interviewing Reiner Labitzke I was attracted by his enthusiastic dedi­ cation to biomechanical research projects. His constructive criticism of the clas­ sic tension band technique of fracture fIxation had led him already to a new con­ cept of bipolar compression by lateral tension banding. Disappointed by a high rate of instability and delayed union of olecranon fractures treated with the AO technique of placing the prestressed wire furthest from the load axis, we changed to Labitzke's technique of bilateral cable tension banding, which proved to be the perfect solution to our instability problems. During the following years, from 1976 -1980, Reiner Labitzke successfully studied the fields of biomechanics and metallurgy. Besides his daily work as a surgeon, his valuable conceptional input was rightly felt to merit recognition. He developed a new method of plate stabilization of flail chest injuries, intro­ duced a "sleeve-rope closure" of median sternotomy in open heart surgery, modified bone instruments and implants in accordance with biomechanical re­ sults from the basic laboratory, and evaluated the methods developed by careful clinical evaluation of the patients during their initial treatment and follow up. The "Manual of Cable Osteosyntheses" is an abstract of his biomechanical re­ search and a comprehensive report of the remarkable clinical results he achieved within 20 years of operative fracture fixation. It can be recommended to surgeons specialized in trauma and orthopedic surgery, for their routine work and as advice in special cases. Univ.-Prof (em.) Dr. med. K.-P. Schmit-Neuerburg, Essen - - - - - - - - Foreword- - I find this book by Reiner Labitzke on the use of steel cables to repair bone de­ fects fascinating because it shows how the excellent options for using steel ca­ bles in the field of technology can be implemented in medicine. It is about na­ ture and human beings and the use of technical devices in life. It says in the Bible: "And God saw everything that he had made, and, behold, it was very good;' But is nature always good and always effective? Is bone good? It breaks if it is subjected to extreme overloading. It is not ideal. No one would ever design the shock strut of an aeroplane or a bicycle frame using artificial bone. Human beings cannot exist without nature, both animate and inanimate, and nature is therefore good, at least for human beings. However, we can also ask the opposite question, one that is quite rightly a central issue in our day and age: Are human beings good for nature? We invent houses, weapons, vehicles for use on land, in the air and in space without any relation to nature. We are afraid of the forces of nature. If nature is very good, why not imitate it? It is now very popular to say that we should take nature as our guide. Of course, we may imitate nature, but it requires skill. "Our new design was inspired by nature" is something you often read, or even "Frei Otto studied spider webs and was thus able to build his wide-span roofs with thin nets of steel cables, such as the roof for the Olympic Stadium in Munich;' Such statements are frequently made in books about bionics, but they are usually wrong. Spider webs did not serve as a model, not even subconsciously. My roofs were built using the particular features of steel wire cables and the existing tech­ niques used to construct cranes and suspension bridges, combined with the age-old production methods for tents and sails, and improved on the basis of new theoretical models of how to minimise the amount of material and energy required. In the 1960S, when the first extremely thin, very wide-span nets hung in the air, the biologists involved in spider research recognised the similarity. Zoolo­ gists, architects, engineers and cable specialists compared ropes, knots, founda­ tions and anchor points and did in fact discover real similarities between the webs spun by spiders and the nets constructed by architects. Both bear loads, are elastic, relatively fixed, are made of very thin, high -tensile, flexible elements and have a similar shape. However, spiders spin their webs to catch insects as they always have done ac­ cording to genetically anchored construction plans, while we continue to im­ prove the construction oflarge net roofs to protect us against the rain and cold using the knowledge obtained in technology and architecture. Little has changed in reality, but all those involved have learned from each other. The zo- X Foreword Frei Otto ologists have increased their understanding of human technology, while the ar­ chitects have increased their understanding of the constructions found in na­ ture. That is the first step towards regarding nature as a whole. Bone is a part of nature, a part of human beings.
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