By Professor Friedrich Pauwels Dr. med., Dr. med. h. c., Dr. Ing. E. h. (auth.)
The contents of this ebook are established virtually completely on only anatomical researches. those have been encouraged by way of questions posed in scientific perform. the consequences are directed to working towards surgeons. Their chronological series ends up in a step-by-step improvement of theoretical bases and to a innovative rejection of previous conceptions. specifically within the box of orthopaedic surgical procedure, a liable angle is feasible neither with out sturdy anatomical wisdom, nor with out an idea of sensible relationships. W. Roux had already verified this and he sought after his works of useful anatomy to be thought of from this standpoint. He exceptionally preoccupied himself with a uniform concept of practical model. therefore it truly is comprehensible that the theories ofRoux shaped the root from which to begin. Our personal researches appeared at the start to corroborate the guidelines of Roux, not less than partially. this can be nonetheless obvious within the monograph touching on fractures of the femoral neck. Later it seemed that ST. KROMPECHER had made a step forwards within the subject of chondrogenesis while he deserted the shear idea postulated by way of Roux and held that compression was once the single potent stimulus for the forma tion of cartilage. The learn about the therapeutic of fractures is predicated in part at the idea of KROMPECHER which was once new at the moment. yet finally progressively more discoveries may not be defined via this perception which used to be basically a little bit varied from the older theories (1. WOLF, W. Roux, W.
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Extra resources for Biomechanics of the Locomotor Apparatus: Contributions on the Functional Anatomy of the Locomotor Apparatus
53). On the contrary, the adduction fracture belongs to the type 3 fractures. These are characterized by the fact that the regeneration tissue is subjected simultaneously to great shearing and tension (Fig. 54). 30 The Fracture of the Femoral Neck. A Mechanical Problem Fig. 48 (12. 3. 25) Fig. 32) Fig. 49 (21. 3. 51 (24. II. 32) The Effect of Loading about the formation of a pseudarthrosis. The fault lies with the effective shearing force The theoretical considerations further ex- which acts entirely on the unprotected replain why callus formation is not always fa- generation tissue whereas in a shaft fracture voured by loading a fracture of the neck of with the same inclination of the fracture the femur, contrary to other fractures.
This is now understandable because, even with an effective initial treatment, harmful mechanical stimuli develop their complete effect on the regeneration tissue only when loading is begun. The case shown in Fig. 50 appeared consolidated after 6 months of treatment by WHITMAN'S method. The X-ray (Fig. 5 I), taken 3 months after loading was begun, showed a typical clear zone and the progressive disappearance of the femoral neck. As the mechanical analysis of the case indicates (Fig. 52), as a result of the marked inclination of the fracture surface, when it was loaded, an active shearing force of considerable magnitude acted on the bony regeneration tissue perhaps already partiaUy formed.
The nail eliminates the action of damaging mechanical stimuli and assures the regeneration tissue a functional compressive stressing which encourages the formation of bony callus in a remarkable way. The therapeutic value and the specific action of nailing and of screwing appear clearly in each individual case when one studies their action in different fractures. One must bear in mind that a nail and screw themselves only have a limited capacity to withstand mechanical stressing. Both represent a technical contrivance to take up the shearing stressing and to eliminate this from between two surfaces.