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Foreword

Howard Rosen

PEOS = Principles of Equine OsteoSynthesis

EBEQOS = Electronic Book of Equine OsteoSynthesis

It is indeed a pleasure and an honor to be asked again to write the Foreword to the book, The Principles of Equine Osteosynthesis (PEOS). The authors are to be congratulated on their exciting innovations in this piece. With your forbearance, I have repeated portions of the foreword of its predecessor, the Electronic Manual of Equine Osteosynthesis (EBEQOS) for historical background and have added a summary of the newer techniques, principles, and ideas included in this new work.

AO = Arbeitsgemeinschaft für Osteosynthesefragen/ Association for the Study of Internal Fixation was founded in 1958

Before the Swiss Association for the Study of Internal Fixation, AO, was established in 1958, the treatment of animal fractures, and indeed human fractures, was mostly by closed reduction, splint, and cast immobilization. Less than adequate simple internal and external fixation appliances were used when the occasional open reduction was performed, and usually required casting as well. Thus disability followed fracture treatment in a high percentage of cases, as functional after treatment was prevented by the long periods of cast immobilization. This resulted in stiffness, swelling, disuse atrophy, and, frequently, deformity.

With the advent of the AO principles of open reduction—anatomic reduction, rigid (stable) internal fixation, careful soft tissue handling, and early functional mobilization with protected weight bearing as tolerated—invalidity after fracture treatment decreased tremendously. This, of course, was accompanied by better instruments and appliances, better metallurgy, aseptic techniques and antibiotics to decrease infection, and better diagnostic modalities. The principles and techniques for successful internal and external fixation of fractures, non-unions, osteotomies, and fusions were annotated in the first editions of the human, canine, and equine AO manuals. These were based on an extensive documentation of thousands of successful results using these techniques, as well as careful analysis of problems and poorer results. As a result of the need for documentation, an extensive classification system of the vast numbers of fracture patterns was created in both humans and animals.

At the AO Research Institute in Davos and in other research centers, through animal experimentation and fundamental cellular and bio-mechanical research, as well as human and animal clinical trials, the AO concepts have been continually tested and refined. The basis for these concepts have thus been scientifically established, and newer methods and ideas have constantly evolved.

These trends and advances in recent years in human osteosynthesis, and in animals applicable as well, have been:

1 More extensive preoperative planning utilizing better diagnostic radiographic, CT, and MRI imaging and bone scans of the injured and normal side.

2 More emphasis on biology and less on mechanics to attain more rapid fracture healing, e.g., opening a diaphyseal fracture for its reduction utilizing smaller incisions and less invasive and traumatic indirect reduction techniques (as if closed treatment of these fractures were being utilized).

3 Less hardware to achieve stable fixation, e.g., fewer screws in plates, and transcutaneously inserted cannulated lag screws for both diaphyseal and metaphyseal articular fractures, as well as the use of arthroscopy to monitor accurate joint reduction.

4 Better appliances that cause less avascularity, e.g., limited contact dynamic compression plates (LC-DCP); PC-Fix plates; closed IM nails with locking screws (both unreamed and reamed); dynamic hip screws (DHS), dynamic compression screws (DCS), and other special plates for metaphyseal-diaphyseal fractures where accurate reduction and stable fixation are essential.

5 Temporary external fixation of the adjacent diaphyseal fracture fragments in conjunction with screw fixation of metaphyseal articular fractures to minimize the need for long and multiple plates.

6 Better tolerated, more elastic metallic fixation through titanium.

7 More advanced external fixation techniques utilizing Ilizarov principles for lengthening, segment transport, and deformity correction in fresh fractures and non-unions.

8 New techniques, instruments, and implants for the treatment of human pelvis, acetabulum, hand, feet, and spine fractures. In addition, computer and robotic-assisted surgery as well as special implants to fit the varied sizes and shapes of animal bones.

9 Better bone-grafting techniques including allografts and bone substitutes.

10 Extensive classification of fractures and soft tissue injuries; and newer techniques for computer documentation.

11 More careful postoperative management to ensure return of function and prevent loss of the race between implant failure and fracture healing.

A great many of these newer advances and techniques are applicable to large animals and are incorporated in PEOS. The work encompasses the more extensive large animal osteosynthesis applications and techniques that were developed in the 5 years since the publication of EBEQOS. Finally, the most innovative and exciting change in PEOS is its refinement of the electronic format utilizing CD-ROM for a true multimedia approach to teaching equine fracture treatment. With simple commands the reader can switch from text to figures, to animation, to videos. Indeed this pioneering computerization is to be a template for the upcoming human manual—another first for veterinary orthopedics and the authors!

PEOS has two additional chapters: on humeral fractures encompassing better compression technology, and on documentation including the AO Vet Equine Documentation System itself. There have also been added full length videos on the use of the dynamic condylar screw plate (DCS/DHS) systems in the treatment of short oblique distal fractures of the adult radius.

The bibliography style has been changed to the one adopted by AO Publishing to be utilized in the books to be published in the future.

This edition also encompasses newer concepts, advances, and techniques, seeking the true etiologies of conditions we deal with—such as biomechanics and tissue growth factors. Newer implants and instruments are shown, but biologic fixation will be stressed where applicable in large animals. Local antibiotics via loaded polymethylmethacrylate (PMMA) beads, more constructive use of allografts, and expanded use of nuclear scintigraphy, MRI, and CT scanning for better and earlier diagnosis and more effective intervention have also been incorporated.

Finally, the greater use of electronic technologies in everyday practice and teaching, utilizing documentation and computer-aided learning methods, have been given an impetus by this book, propelling these advances well into the new millennium.

It is still strongly suggested that the user complement the book's informative guidance through equine osteosynthesis by obtaining specialized practical training at an AO course or at a school where these exacting techniques can be practiced on plastic bones and/or cadavers. To insure the best possible clinical results, however, careful soft tissue handling, aseptic operating room conditions and good preoperative and postoperative management should be practiced, in addition to the proposed osteosynthesis.

In conclusion, I wish all the practitioners and students who utilize the AO techniques promulgated in this exciting new work the best of luck in obtaining excellent functional results following their repair of equine fractures. I also congratulate the authors, editors, and publishers once again on a job well done.