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This document contains the learning objectives for the core and optional content of the AO Trauma Course—Basic
Principles of Fracture Management. The sequence of activities in this template follows the course template for a 3-day
Basic Principles course.
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Course objectives for the Basic Principles of Fracture Management Course
Discuss the concepts of stability, their influence on bone healing, and how to apply implants to achieve
appropriate stability
Plan a treatment based on assessment, imaging, classification, and decision making
Apply reduction techniques in fracture management with attention to the importance of the soft-tissue
Use appropriate fixation techniques to treat diaphyseal and simple (peri)articular fractures
Evaluate and recognize the special problems related to; fractures in the immature skeleton, pelvic injuries,
osteoporotic fractures, postoperative infection and delayed union and/or nonunion
Plan the initial treatment of the polytraumatized patient
1 – General principles
https://emodules.aoeducation.org/aoelearn/aot_launch/aot_bh/lib/launch.html?bone_healing
Additional information on the 2018 revision of the AO/OTA Fracture and Dislocation Classification Compendium can be
found here:
https://classification.aoeducation.org
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Lectures
Module 1: General principles
Teaching points: Integrate history, philosophy, current offerings (AO Surgery Reference, online
resources, Research, etc.) into this lecture.
Learning objectives
The effect of patient factors and injury mechanism on fracture management 15'
Learning objectives
Teaching points: General and local factors affecting management decisions. The concept of the energy of
the injury. Introduce the priorities of life saving, limb saving, and disability limiting surgery. Discuss the
priorities of the multiply injured patient with orthopaedic injuries; do not go into details and refer to lecture
Treatment algorithms for the polytrauma patient.
Learning objectives
Teaching points: Explain the role of soft-tissues in resisting infection, facilitating healing, and promoting
function. Present the pathophysiology of compartment syndrome and overview of diagnosis and
treatment. Do not go into details of fracture management.
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Absolute stability: biomechanics, techniques, and fracture healing 15'
Learning objectives
Learning objectives
Learning objectives
Learning objectives
Learning objectives
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At the end of the lecture, the participant will be able to:
Recognize the need and purpose of a fracture classification system
Describe the Fracture and Dislocation Classification system and its clinical importance for
decision-making and preoperative planning
Outline the structure of this classification for long-bone fractures
Name the bone segments and use their numerical code
List types, groups, subgroups, qualifiers, and universal modifiers
Properly classify long-bone fractures
Learning objectives
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Module 2: Treatment of diaphyseal fractures
Learning objectives
Learning objectives
Teaching points: This must be a general presentation and specific treatment strategy will be discussed in
the Advances course. Avoid controversial evidence apart from the advice to use two distal interlocking
screws in IM nailing to improve stability.
Learning objectives
Teaching points: The force required to fracture femur should be emphasized. The soft-tissue cover favors
good results with IM nailing. Dynamization techniques need to be mentioned. Classification can be added.
Learning objectives
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Teaching points: Concentrate on closed fractures, but briefly refer to open fractures.
Learning objectives
Teaching points: Describe the advantages of the newer generation reamers and other techniques to
decrease thermal and pressure effects of reaming.
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Module 3: Treatment of articular fractures
Management principles for articular fractures—how do they differ from diaphyseal fractures? 20'
Learning objectives
Learning objectives
Learning objectives
Teaching points: Understanding that multi-directional forces cause different fracture patterns and define
soft tissue involvement.
Learning objectives
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Describe potential complications after treatment of femoral neck fractures
Teaching points: Timing of intervention, rationale for arthrotomy and patient considerations.
Learning objectives
Learning objectives
Teaching points: Focus on soft tissue, imaging, and MIO. Do not go into details of fixation!
Learning objectives
Learning objectives
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At the end of the lecture, the participant will be able to:
Describe different types of distal radial fractures
List indication for operative and nonoperative treatment
Outline surgical approaches for the fixation of distal radial fractures
Describe appropriate reduction techniques
Choose appropriate implants according to fracture type
Discuss indications for conventional and locking plates
Teaching points: Participants should appreciate the multitude of treatment options and their indications
with regard especially to patient needs.
Learning objectives
Teaching points: Participants should recognize that indirect reduction using a distraction tool greatly
facilitates adherence to principles of treating articular fractures. Angular stability should be stressed to avoid
secondary loss of alignment.
Teaching points: Indirect reduction utilizing joint-spanning distraction for preliminary stabilization and
correction of length and alignment should be part of this lecture.
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Module 4: Preoperative planning and forearm fractures
Learning objectives
Teaching points: Using a management concept for each patient and planning each surgical procedure
avoids complications and gives the orthopedic surgeon security in contemplating each step of treatment for
which he or she is totally responsible.
Learning objectives
Teaching points: Correct length and alignment of both radius and ulna are prerequisites for elbow and
wrist congruency.
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Module 5: Emergency management and minimally invasive surgery
Learning objectives
Learning objectives
Teaching points: Include emergency management of the cervical spine if there is no separate lecture
planned on this topic.
Emergency management of pelvic fractures—a critical skill that can save lives 15'
Learning objectives
Teaching points: Focus on pattern recognition on x-rays, describe how to use binders and sheets
appropriately.
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Learning objectives
Teaching points: Focus on concept of soft-tissue windows and on the importance of diminishing surgical
footprints.
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Module 6: Special issues and problems
Learning objectives
Learning objectives
Teaching points: Focus on the importance of early diagnosis and aggressive surgical treatment, on when
to retain/remove implants.
Learning objectives
Teaching points: Highlight the impact of disrespect of biomechanics and biology in leading to delayed
healing.
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Learning objectives
Teaching points: The lecture should illustrate outcomes that invariably are to be expected when neglecting
the principles of fracture and soft-tissue management.
Learning objectives
Teaching points: Focus on general principles of orthogeriatric management and the principles of fixing
osteoporotic fractures.
Learning objectives
Teaching points: Focus on anatomy and principles of fracture care in the growing skeleton. Do not go into
the details of each fracture.
Learning objectives
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Describe the different techniques to do it
Understand when to remove implants
Teaching points: Focus on the importance of appropriate planning of these surgical procedures.
Learning objectives
At the end of the lecture, the participant will be able to:
Discuss trends in new implant technology
List research topics currently concerned with bone healing
Appreciate new theories of fracture treatment such as gene therapy / stem cell research
Learning objectives
Appreciate the value of reviewing the history and development of fracture treatment
Respect the contribution of the Founders of the AO
Realize that success in AO developments depends on clinical expertise, documentation, research
and education (4 pillars of the AO)
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Skills Lab
"Fracture healing"
After participating in this simulation, the participant will be able to:
Identify the importance of the increasing cross-section
Identify the importance of tissue transformation between fragments
Define absolute and relative stability
Define the importance of initial gap width onto cell deformation under the condition of relative
stability
Define the effect of tissue differentiation on deformation
"Techniques of reduction"
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After participating in this simulation, the participant will be able to:
Differentiate between direct and indirect reduction
Relate both techniques to specific indications and bone segments
Identify the degrees of freedom for each reduction clamp
Recognize difficulties in the application of the different devices
Analyze biological advantages and shortcomings of different clamps
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"Torque measurement of bone screws"
After participating in this simulation, the participant will be able to:
Feel and achieve optimal torque in different bone qualities
Practice over- and under tightening screws in bone cortex
Investigate potential problems when inserting the screwdriver into the screw head
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After participating in this simulation, the participant will be able to:
Describe different nail designs and their mechanical characteristics
Explain radial preload and corresponding concept of stabilization
Describe indications for nailing without interlocking
Identify common problems when using nails that are too short or too thin
Describe possible problems of nailing without interlocking
Describe different nail locking options and possible influences on stability of fixation (dynamic
versus static locking
Explain elastic stable intramedullary nailing
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Small group discussions
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Practical exercises
Learning objectives
Teaching points: This exercise builds upon the contents of the lecture Absolute stability: biomechanics,
techniques, and fracture healing. There is a second part of the video with additional exercises. If you plan to
do the exercises of the second part as well, you will need to add another 60 minutes to this exercise for the
second part. See description of second part under “Optional activities”.
Principle of the internal fixator using the locking compression plate (LCP) 70'
Video: 00112
Bone model: 1142
Bone model: 0068 (bridge plating MIPO)
Bone model: 0081 (angular stability in osteoporotic bone)
Learning objectives
Teaching points: This exercise builds upon the contents of the lectures Fracture fixation using locking
plates and Relative stability: biomechanics, techniques, and fracture healing as well as Absolute stability:
biomechanics, techniques, and fracture healing.
Please choose one of the following. Time permitting, a second exercise can be performed (add an extra 30
minutes)
Video: 00116 (tibia modular external fixator)
Bone model: 1111
Video: 00119 (ankle bridging modular external fixator)
Bone model: PR0535
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Video: 00120 (knee bridging modular external fixator)
Bone model: PR0536
Teaching points: Consider temporary vs definitive management issues, and the soft-tissue injury.
Option 1
Tibial shaft fractures—intramedullary nailing with the expert tibia nail (ETN) (with reaming)
Video: 00130
Bone model: 1149 – 01
Bone model: ASLS perspex model
Option 2
Tibial shaft fractures—intramedullary nailing with the expert tibia nail enhanced (ETN Enhanced)
Video: 00136
Bone model: LD1149-01
Option 3
Intramedullary fixation using the expert retrograde/antegrade femoral nail (R/AFN)–antegrade procedure
Video 00140
Bone model: PR0340
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State the clinical indications and contraindications
Describe the correct patient positioning
Identify the correct entry point for antegrade nailing
Explain the steps used to perform the surgical procedure
Teaching points: Correct entry points should be discussed, and the steps of the exercise repeated before
starting. It should be mentioned that in the plastic bone the reaming must be evacuated repeatedly to
avoid jamming of the reamer.
Templating exercise
Learning objectives
Teaching points: Participants are asked to develop a complete preoperative plan for a type 22-C1.3
forearm fracture based on x-rays of the uninjured and injured forearm bone model. A syllabus for this
exercise is available in the online Faculty Support Package.
Operate your plan—fixation of a 22C1 forearm fracture using the LCP 3.5 (8 and 11 holes) 70'
Video: 00113
Bone model: 6501
Bone spreader 399.100 for every table
Learning objectives
Learning objectives
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olecranon fracture
Develop tips and tricks to reduce the incidence of complications
Teaching points: Participants should remember the fine points of parallel K-wires, producing ease of K-
wire fixation by first penetrating the far cortex and bending the obliquely cut tips of the K-wires through180
degrees, so that they can be tapped into the bone. Emphasize the use of two twirls.
Option 1
Stabilization of femoral neck fractures using the DHS system
Video: 00137
Bone model: LD2220.01
Option 2
Intramedullary nailing of a proximal femur using a proximal femoral nail anti-rotation (PFNA)
Video 00125
Bone model: LD2220
Teaching points: Participants should be made aware of the complexity of the implant and the importance
of following the steps of instrumentation. The correct entry point for the nail and the correct angle of
initial reaming should be stressed.
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Stabilization of the pelvic ring using a large external fixator 70'
Video: 00122
Bone model: 4083
Learning objectives
Learning objectives
Teaching points: Participants should recognize that instruments of reduction can facilitate fixation greatly
and that distraction and correction of length and alignment can be accomplished by traction table and
femoral distractor.
Internal fixation with screws and plates (optional additional part): LCP as a compression plate with a 65'
lag screw, buttress plating
Video 00110
Bone model: 0067
Bone model: 1143
Learning objectives
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At the end of the exercise, the participant will be able to:
List the indications and contraindications for the use of the 7.3 mm cannulated screw in femoral
neck fractures
Demonstrate the insertion of the screws in optimal position
Understand the use of the C-arm, its positioning in relation the patient
Teaching points: Discuss the alternatives of transcutaneous screw placement and open screw placement.
Explain reduction techniques.
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