American medicine remains in the midst of a profound and wrenching transformation. The government, Wall Street, third party payers, and patients have demanded improved medical care at lower cost. Better medicine (orthopaedics) occurs when doctors practice medicine consistently on the basis of the best scientific evidence available, set up systems to measure performance, analyze results and outcomes, and make this information widely available to patients and the public. Reduced costs have been achieved partially through a wholesale shift to health maintenance organization, capitation, and managed care.

 

Trauma is a complex problem where initial decisions often dramatically determine the ultimate outcome. Death, deformity, and medicolegal entanglements may follow vacillation and error. When treatment is approached with confidence, planning, and technical skill, the associated mortality rate, preventable complications, permanent damage, and economic loss may be significantly reduced. Uncertainty, inactivity, and inappropriate intervention by physicians are all detrimental to patient care. Certain traditional concepts and fixation techniques need to be abandoned and new approaches learned.

 

This text attempts to address society's mandate to our profession: better orthopaedics at reduced cost. It provides residents and practitioners with surgical approaches to 46 common but often problematic fractures that, when correctly done, have proven to be safe and effective. It is my hope that the second edition of this textbook remains a valuable fixture in the catalog of literature on fracture management.