Learning From Failures in Orthopedic Trauma

Key Points for Success

Editors: Miquel Videla Cés, J Miquel Sales Pérez, Joan Girós Torres, Roberto Rivero Sosa

Introduction to internal fixation

1.1 The evolution of internal fixation over the last 20 years

Breaches of AO Principles

2.1	General considerations on violation of AO principles
2.2	Osteosynthesis in unreduced fractures
2.3	Principles of stability, selection of implants, and the combination of absolute and relative stability
2.4	Biology management (including soft-tissue management)

Implant-related issues

3.1	Implant selection issues
3.2	Type of implant related to biomechanical principles
3.3	Implant size, prebending, molding, and shape adapted to the fractured bone
3.4	Anatomical implants: ready-to-wear versus custom fit
3.5	Designs and techniques of intramedullary naling
3.6	Failures due to guided targeting and implant assembly

Surgical team

4.1	Determining factors for failures relating to the surgical team
4.2	Insufficient preparatory planning, including alternatives
4.3	Lack of anatomical knowledge
4.4	Insufficient asepsis protocols
4.5	Proficiency and experience
4.6	Accumulation of failures

Postoperative management

5.1	General considerations in postoperative management of internal fixation
5.2	Physiotherapy
5.3	Implant removal

Patience compliance

6.1 Failures unrelated to the healthcare team but related to patient compliance
Failure recognition and timing

7.1 Early recognition of failures
The learning circle

8.1 The learning circle: tips and tricks to minimize failures
Bizarre failures

9.1 Difficult to classify