Osteosynthese Mini Invasive Des Fractures Du Radius Distal

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Internal Fixation of Small Fractures

Author : Urs Heim
Publisher : Springer Science & Business Media
ISBN 13 : 3642726143
Total Pages : 395 pages
Book Rating : 4.6/5 (427 download)

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Book Synopsis Internal Fixation of Small Fractures by : Urs Heim

Download or read book Internal Fixation of Small Fractures written by Urs Heim and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 395 pages. Available in PDF, EPUB and Kindle. Book excerpt: The second English-language edition of the Small Fragment Set Manual was enthusiastically received and quickly went into a second printing. In preparing a third edition, we found it necessary to revise the text extensively and partly restructure it. The reasons for this are numerous. Experience of recent years has brought technical refinements in the operative treatment of many types of small fracture. Many of these changes stem from the small-fragment-set training programs conducted in Switzerland since 1980, and also from courses and symposia that have been held in other European countries and the United States. These events were occasions for a fruitful ex change of experience with surgeons who were critical of our methods. As a result of this exchange, we perceived a need both to revise our indications and to give greater attention to alternative techniques. We also felt it necessary to respond to criticisms of the first two editions concerning the catalog-like instrument lists and illustrations, and the attention given to fundamental techniques. Many surgeons who work or would like to work with small implants, especially those practicing abroad, are inexperienced in operations on the larger bones. It is imperative that these colleagues be given a basic introduction to the "biomechanical thinking" of the Swiss Association for the Study of Internal Fixation (ASIF).

Distal Radius Fractures

Author : Geert Alexander Buijze
Publisher : Elsevier Health Sciences
ISBN 13 : 0323757650
Total Pages : 459 pages
Book Rating : 4.3/5 (237 download)

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Book Synopsis Distal Radius Fractures by : Geert Alexander Buijze

Download or read book Distal Radius Fractures written by Geert Alexander Buijze and published by Elsevier Health Sciences. This book was released on 2021-02-23 with total page 459 pages. Available in PDF, EPUB and Kindle. Book excerpt: Edited and authored by leading international experts, Distal Radius Fractures: Evidence-Based Management provides a state-of-the-art overview of diagnosis and management based on today's best practices. Each chapter focuses on one key issue, offering a challenging case and then questioning the reader in an engaging fashion to provide the best available evidence on each topic. Practical and easy to read, this innovative text is a useful resource for all residents, physicians and surgeons who manage fractures. - Combines current best practices with the knowledge and experience of a global team of expert contributing authors, with a focus on practical use in applying the evidence. - Covers need-to-know topics such as anatomy and biomechanics, diagnostic management, acute fracture management, management of pediatric and elderly fractures, and more. - Includes valuable case scenarios, technical tips and tricks, and pearls and pitfalls. - Features high-quality illustrations including CT scans, x-rays, and clinical photographs. - Consolidates the latest evidence on distal radius fractures into one convenient resource.

Minimally Invasive Fracture Repair, An Issue of Veterinary Clinics of North America: Small Animal Practice, E-Book

Author : KARL C. Maritato
Publisher : Elsevier Health Sciences
ISBN 13 : 0323754317
Total Pages : 289 pages
Book Rating : 4.3/5 (237 download)

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Book Synopsis Minimally Invasive Fracture Repair, An Issue of Veterinary Clinics of North America: Small Animal Practice, E-Book by : KARL C. Maritato

Download or read book Minimally Invasive Fracture Repair, An Issue of Veterinary Clinics of North America: Small Animal Practice, E-Book written by KARL C. Maritato and published by Elsevier Health Sciences. This book was released on 2019-11-28 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: This issue of Veterinary Clinics: Small Animal Practice, guest edited by Drs. Karl Maritato and Matthew Barnhart, focuses on Minimally Invasive Fracture Repair. Articles in this issue include, but are not limited to: Biomechanics of Fracture Fixation; Challenges in Minimally Invasive Fracture Repair; Minimally Invasive Osteosynthesis Fracture Reduction Techniques; Percutaneous Pinning for Fracture Repair; Minimally Invasive Plate Osteosynthesis Techniques for the Humerus; Minimally Invasive Plate Osteosynthesis Techniques for the Radius and Ulna; Minimally Invasive Osteosynthesis (MIO) Techniques of the Femur; Minimally Invasive Osteosynthesis Techniques for Articular Fractures; Unique Differences of Minimally Invasive Fracture Repair in the Feline; Perioperative Imaging in Minimally Invasive Osteosynthesis; Interlocking Nails for Minimally Invasive Osteosynthesis; Minimally Invasive Plate Osteosynthesis Techniques for Tibia and Fibula; Minimally Invasive Plate Osteosynthesis Techniques for Meta-bones; Minimally Invasive Osteosynthesis Techniques for Sacroiliac Luxation; and Minimally Invasive Plate Osteosynthesis Techniques for Arthrodesis.

The Pediatric Upper Extremity

Author : Joshua M. Abzug
Publisher : Springer
ISBN 13 : 9781461485131
Total Pages : 0 pages
Book Rating : 4.4/5 (851 download)

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Book Synopsis The Pediatric Upper Extremity by : Joshua M. Abzug

Download or read book The Pediatric Upper Extremity written by Joshua M. Abzug and published by Springer. This book was released on 2014-11-22 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Sub-specialization within pediatric orthopedics is growing, in part due to the development of free-standing children's hospitals and the desire by patients and their parents to have "experts" care for them. We are at the forefront of a trend in physicians classifying themselves as pediatric upper extremity surgeons. Numerous pediatric hospitals now have or are recruiting physicians to focus their practice in this area. Historically, these issues were treated by general orthopedic surgeons, adult hand surgeons, pediatric orthopedic surgeons, or plastic surgeons. However, none of these professionals treat the entirety of pediatric upper extremity pathology, and no single reference has focused on the treatment of the pediatric upper extremity as a whole. For example, fractures have typically been written about in pediatric textbooks, while tendon and nerve injuries are covered in adult hand textbooks. This textbook is a comprehensive, illustrated reference that discusses all aspects of the pediatric upper extremity, from embryology and functional development to nerve injuries, trauma, tumors, burns, sports injuries and more.

Rockwood and Green's Fractures in Adults

Author : Robert W. Bucholz
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 1451161441
Total Pages : 2059 pages
Book Rating : 4.4/5 (511 download)

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Book Synopsis Rockwood and Green's Fractures in Adults by : Robert W. Bucholz

Download or read book Rockwood and Green's Fractures in Adults written by Robert W. Bucholz and published by Lippincott Williams & Wilkins. This book was released on 2012-03-29 with total page 2059 pages. Available in PDF, EPUB and Kindle. Book excerpt: In its thoroughly revised, updated Seventh Edition, Rockwood and Green's Fractures in Adults offers a complete print and multimedia package: the established "gold-standard" two-volume reference on fractures and access to an integrated content website. More than 80 of the world's foremost authorities provide comprehensive coverage of all bone and joint injuries, thoroughly discuss alternative methods for treating each injury, and present their own preferred methods. This edition has 33 new contributors and new chapters on principles of nerve injury and complex regional pain syndrome; psychological aspects of trauma; gunshot and wartime injuries; principles of mangled extremity management; amputations; limb salvage reconstruction; principles of post-traumatic infections; principles of nonunions; and principles of malunions.

Fractures of the Distal Radius

Author : Diego L. Fernandez
Publisher : Springer Science & Business Media
ISBN 13 : 1468404784
Total Pages : 355 pages
Book Rating : 4.4/5 (684 download)

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Book Synopsis Fractures of the Distal Radius by : Diego L. Fernandez

Download or read book Fractures of the Distal Radius written by Diego L. Fernandez and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: Fractures of the distal radius are extraordinarily common, but can be complex to treat. This book provides an in-depth understanding of a comprehensive approach to the management of these fractures and their complications. The authors, world renown experts in the field, present practical, clinical information from their extensive experience in the treatment of these fractures. Topics include the authors' classification as well as decision making and tactics in the conservative and operative management of all types of radius fractures: bending fractures of the metaphysis, shearing fractures of the joint surface, compression fractures of the joint surface, avulsion fractures, radio-carpal fractures and dislocation, combined fractures, high velocity injury, and malunions. In addition, comprehensive chapters are included on surgical technique and approach as well as on complications. With over 650 illustrations, this is the definitive volume on these challenging fractures, their complete treatment and management of complications.

Rockwood and Green's Fractures in Adults

Author : Charles Court-Brown
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 1469884828
Total Pages : 6127 pages
Book Rating : 4.4/5 (698 download)

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Book Synopsis Rockwood and Green's Fractures in Adults by : Charles Court-Brown

Download or read book Rockwood and Green's Fractures in Adults written by Charles Court-Brown and published by Lippincott Williams & Wilkins. This book was released on 2014-09-04 with total page 6127 pages. Available in PDF, EPUB and Kindle. Book excerpt: Need the go-to reference on adult bone and joint injuries? Get the definitive guide on fracture treatment, written by the world’s top orthopaedic surgeons: Rockwood and Green’s Fractures in Adults. This fully updated and expanded 8th edition offers up-to-the-minute research and recommendations from more than 80 leading orthopaedic experts from around the world. An essential resource on fractures for every orthopaedic surgeon or resident.. Features: NEW chapters on: Management of the Geriatric or Elderly Patient; Management of Bone Defects;; Psychological Aspect of Trauma NEW authors from countries including India, China, Columbia, Greece, and Denmark NEW 10 new full length videos added to the video library. All videos feature easy navigation so you can go directly to specific steps in the procedure, or watch the entire procedure from start to finish Pearls and Pitfalls and preventive measures listed for all procedures NEW Time-saving outline template for easy quick-reference “Before the Case” checklists of all necessary equipment for each surgical procedure Preferred Technique section provides algorithms explaining each author’s choice of preferred procedure Full-color operative photos, tables, x-rays, diagrams, and more than 500 line drawings of surgical procedures

Minimally Invasive Plate Osteosynthesis (MIPO)

Author : Reto Babst
Publisher : Thieme
ISBN 13 : 3131624124
Total Pages : 785 pages
Book Rating : 4.1/5 (316 download)

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Book Synopsis Minimally Invasive Plate Osteosynthesis (MIPO) by : Reto Babst

Download or read book Minimally Invasive Plate Osteosynthesis (MIPO) written by Reto Babst and published by Thieme. This book was released on 2012-06-13 with total page 785 pages. Available in PDF, EPUB and Kindle. Book excerpt: This textbook offers a comprehensive view of all aspects of minimally invasive plate osteosynthesis (MIPO). The second expanded edition includes the expert knowledge of AO surgeons from all around the world. It not only provides basic concepts and the latest clinical and basic scientific research, but guides the interested surgeon through the crucial steps of MIPO application in the different anatomical regions. Enhanced by clear photographs, x-rays, MRls, CT scans, and detailed illustrations, the book comprises two sections: Section 1, Principles, covers the principles of MIPO surgery as well as education in MIPO. Section 2, Cases, encompasses all anatomical regions. For each region there is a comprehensive introduction covering general aspects of MIPO techniques regarding indications, preoperative planning, and positioning, before indirect and direct reduction and fixation techniques are presented. Case examples then allow the reader to follow each procedure in a thorough, step-by-step manner. Additional chapters on pediatric and fragility fractures, special indications, and implant removal conclude this second section. The main concept behind the MIPO technique is to deal with soft tissue and bone in a way that does not add additional trauma to the fracture site. The bone must be accessed through soft-tissue windows away from the fracture site. Direct reduction maneuvers, if needed, should be executed to leave only small footprints at the fracture area and reduce disturbance of fracture healing.

Locking Plates in Veterinary Orthopedics

Author : Matthew D. Barnhart
Publisher : John Wiley & Sons
ISBN 13 : 111938012X
Total Pages : 256 pages
Book Rating : 4.1/5 (193 download)

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Book Synopsis Locking Plates in Veterinary Orthopedics by : Matthew D. Barnhart

Download or read book Locking Plates in Veterinary Orthopedics written by Matthew D. Barnhart and published by John Wiley & Sons. This book was released on 2018-11-13 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: Locking Plates in Veterinary Orthopedics is a comprehensive and state-of-the-art guide to all aspects of using locking plates to treat orthopedic conditions in dogs, cats, and large animals. • Offers a proven approach to using locking plates in veterinary practice • Highlights practical clinical applications with illustrative clinical cases • Includes information on the history, principles, and materials as well as specific techniques • Presents data on both traumatic and non-traumatic applications • Provides instructive color photographs to demonstrate the procedures

The Rationale of Operative Fracture Care

Author : Joseph Schatzker
Publisher : Springer Science & Business Media
ISBN 13 : 3662024837
Total Pages : 445 pages
Book Rating : 4.6/5 (62 download)

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Book Synopsis The Rationale of Operative Fracture Care by : Joseph Schatzker

Download or read book The Rationale of Operative Fracture Care written by Joseph Schatzker and published by Springer Science & Business Media. This book was released on 2013-06-29 with total page 445 pages. Available in PDF, EPUB and Kindle. Book excerpt: After the publication of the AO book Technique of Internal Fixation of Fractures (Miiller, Allgower and Willenegger, Springer-Verlag, 1965), the authors decided after considerable discussion amongst themselves and other members of the Swiss AO that the next edition would appear in three volumes. In 1969, the first volume was published (the English edition, Manual of Internal Fixation, appeared in 1970). This was a manual of surgical technique which discussed implants and instruments and in which the problems of internal fixation were presented schematically without radio logical illustrations. The second volume was to be a treatise on the biomechanical basis of internal fixation as elucidated by the work done in the laboratory for experi mental surgery in Davos. The third volume was planned as the culminating effort based upon the first two volumes, treating the problems of specific fractures and richly illustrated with clinical and radiological examples. It was also to discuss results of treatment, comparing the results obtained with the AO method with other methods. The second and third volumes were never published. The second edition of the AO Manual appeared in 1977. It dealt in greater detail with the problems discussed in the first edition, although it still lacked clinical exam ples and any discussion of indications for surgery. Like the first edition, it was trans lated into many languages and was well received. Finally, after 22 years, the much discussed and much needed third volume has appeared.

Surgical Treatment of Orthopaedic Trauma

Author : James P. Stannard
Publisher : Thieme
ISBN 13 : 160406630X
Total Pages : 979 pages
Book Rating : 4.6/5 (4 download)

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Book Synopsis Surgical Treatment of Orthopaedic Trauma by : James P. Stannard

Download or read book Surgical Treatment of Orthopaedic Trauma written by James P. Stannard and published by Thieme. This book was released on 2011-01-01 with total page 979 pages. Available in PDF, EPUB and Kindle. Book excerpt: Winner of First Prize in Orthopaedics and Rheumatology at the 2008 British Medical Association Medical Book Competition Winner of Association of American Publishers Best Book in Clinical Medicine, 2007This landmark multimedia reference presents the most current information on surgical treatments of a wide range of injuries, from complex pelvic and spinal trauma to periarticular fractures and knee dislocations. For each injury, the authors guide the reader from the clinical evaluation, through the decision-making process, and to the surgical procedure. Each chapter provides a thorough review of surgical anatomy, streamlined discussion of the classification of the injury, the non-operative treatments available, and the indications for surgical treatment. Concise, step-by-step descriptions of surgical techniques are supplemented by carefully edited videos of surgical procedures on four accompanying DVDs, containing over 18 hours of video footage. Highlights of the book: Tips and Tricks summarize key points of each procedure for rapid review in preparation for surgery Exam Pearls describe injuries, incidence, indications for surgery, and possible complications and are ideal for board preparation More than 1,400 photographs, radiographs, and drawings illustrate techniques New Techniques sections cover the latest innovations for surgical management A separate table of contents for the four DVDs and shaded text boxes throughout the book enable convenient book-to-video reference Highlights of the DVDs: Narrated videos of entire surgical procedures provide a window into the operating room--an invaluable resource for residents and general orthopedic surgeons who do not perform trauma procedures regularly Coverage of state-of-the-art techniques such as locked plating, minimally invasive fracture fixation, advanced intramedullary nailing strategies, staged reconstruction of periarticular fractures, new techniques for hip hemiarthroplasty, surgical management of knee dislocation, including double bundle ACL and PCL knee reconstruction, and the use of temporary postoperative hinged external fixation Each DVD has been professionally produced and features high-quality audio, special effects, and multiple camera angles for each procedure Authoritative and comprehensive in its scope, this landmark text will be an invaluable asset in libraries of all orthopedic surgeons, residents, or specialists seeking a comprehensive and didactic reference.

Rockwood and Green's Fractures in Adults

Author : Charles A. Rockwood
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 1605476773
Total Pages : 2059 pages
Book Rating : 4.6/5 (54 download)

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Book Synopsis Rockwood and Green's Fractures in Adults by : Charles A. Rockwood

Download or read book Rockwood and Green's Fractures in Adults written by Charles A. Rockwood and published by Lippincott Williams & Wilkins. This book was released on 2010 with total page 2059 pages. Available in PDF, EPUB and Kindle. Book excerpt: In its thoroughly revised, updated Seventh Edition, Rockwood and Green's Fractures in Adults offers a complete print and multimedia package: the established "gold-standard" two-volume reference on fractures and access to an integrated content website. More than 80 of the world's foremost authorities provide comprehensive coverage of all bone and joint injuries, thoroughly discuss alternative methods for treating each injury, and present their own preferred methods. This edition has 33 new contributors and new chapters on principles of nerve injury and complex regional pain syndrome; psychological aspects of trauma; gunshot and wartime injuries; principles of mangled extremity management; amputations; limb salvage reconstruction; principles of post-traumatic infections; principles of nonunions; and principles of malunions. A companion website contains the fully searchable text, an image bank, and videos of 25 surgical procedures.

Feline Orthopedic Surgery and Musculoskeletal Disease

Author : P. M. Montavon
Publisher : Elsevier Health Sciences
ISBN 13 : 0702037338
Total Pages : 587 pages
Book Rating : 4.7/5 (2 download)

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Book Synopsis Feline Orthopedic Surgery and Musculoskeletal Disease by : P. M. Montavon

Download or read book Feline Orthopedic Surgery and Musculoskeletal Disease written by P. M. Montavon and published by Elsevier Health Sciences. This book was released on 2009-07-14 with total page 587 pages. Available in PDF, EPUB and Kindle. Book excerpt: This eBook provides access to the complete book content electronically. Pageburst (formerly Evolve eBooks) allows you to quickly search the entire book, make notes, add highlights, and study more efficiently. Buying other Pageburst titles makes your learning experience even better: all of the eBooks will work together on your electronic "bookshelf", so that you can search across your entire library of eBooks. Feline Orthopedic Surgery and Musculoskeletal Disease is the first book dedicated specifically to treating cats with disorders in this specific area. The practice of feline orthopedic surgery and traumatology has developed to a great extent over the last ten years as cat ownership is increasing and this textbook discusses new veterinary diagnostic procedures and surgical techniques that have been developed that veterinarians, residents and students working in the field of internal medicine need to know about. - Covers the basics of feline anesthesia, analgesia, preoperative and postoperative care of the patient, orthopedic instrumentation and implants - Contains detailed sections on investigation and diagnosis of feline orthopedic diseases and injuries, with specific chapters on diseases of the footpads and nails, tumors of the musculoskeletal system, and polytrauma - Surgical techniques of feline orthopedic diseases and injuries are explained step-by-step with many schematic illustrations - Presents both classical treatments using cost-effective implants and new osteosynthesis techniques using modern implants - Over 20 new and original surgical methods are included

Equine Fracture Repair

Author : Alan J. Nixon
Publisher : John Wiley & Sons
ISBN 13 : 081381586X
Total Pages : 933 pages
Book Rating : 4.8/5 (138 download)

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Book Synopsis Equine Fracture Repair by : Alan J. Nixon

Download or read book Equine Fracture Repair written by Alan J. Nixon and published by John Wiley & Sons. This book was released on 2020-01-09 with total page 933 pages. Available in PDF, EPUB and Kindle. Book excerpt: Offers a long-awaited Second Edition of this comprehensive, state-of-the-art reference for fracture repair in horses The Second Edition of Equine Fracture Repair has been thoroughly revised and updated to present the most current information on fracture repair in horses. Written to be accessible, the text is logically arranged, presenting the most authoritative information on equine fracture repair with explanations of the expected outcomes. The book provides valuable insight as to whether a fracture should be repaired, the degree of difficulty of the procedure, and a wealth of practical information on surgical techniques. This fully revised Second Edition offers a valuable tool for veterinarians making clinical decisions when faced with horse fractures, covering emergency care and splinting, the most current innovative techniques in equine fracture repair, and new implant systems. With contributions from leading experts in the field, the revised edition continues to be the essential reference to the subject. This essential resource: Offers a revised edition of the most comprehensive reference on the repair of fracture in horses, with complete information on patient assessment, emergency splinting and casting, and guidance in treatment choices Includes contributions from leading experts in the field Presents information organized by fracture type for quick access Provides valuable outcome assessment with helpful discussions of the degree of difficulty to aid in case management, incorporating information on the newest techniques and implant systems Concludes with extensive information on the identification and management of complications associated with fractures and repair methods This revised and updated edition of Equine Fracture Repair continues to provide a comprehensive resource for understanding the most effective and current techniques available for the treatment of fractures in horses.

Distal Radius Fractures and Carpal Instabilities

Author : Francisco del Pinal
Publisher : Thieme
ISBN 13 : 3132423807
Total Pages : 662 pages
Book Rating : 4.1/5 (324 download)

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Book Synopsis Distal Radius Fractures and Carpal Instabilities by : Francisco del Pinal

Download or read book Distal Radius Fractures and Carpal Instabilities written by Francisco del Pinal and published by Thieme. This book was released on 2019-06-24 with total page 662 pages. Available in PDF, EPUB and Kindle. Book excerpt: A comprehensive summary of the state of the art in the management of fractures of the distal radius and carpal instability Hand and wrist fractures account for millions of emergency room visits annually. The extraordinary importance of these structures in activities of daily living necessitates great surgical competence in repairing fractures, so as to preserve the vast range of motion and utility of this functional anatomic unit. The management theory and techniques for these fractures have seen dramatic changes in the last few decades. This new volume brings together all currently established operative techniques for distal radius fractures, explained in detail and highly illustrated, step by step, with a wealth of brilliant figures and diagrams. Key Features: Comprehensive coverage of all types of injury as well as all the evidence-based therapeutic surgical options State-of-the-art management of carpal instability, anterior and dorsal rim fractures, radiocarpal dislocation, malunion, and much more Includes coverage of ligamentous injuries Contributions by numerous world-renowned surgeons This book is ideal for all surgeons in training in orthopaedic surgery and in plastic surgery, and of benefit to experienced surgeons as well.

Proceedings 2021 Joint AAZV EAZWV Conference

Author : Charlotte Kirk Baer
Publisher : BoD – Books on Demand
ISBN 13 : 3754337068
Total Pages : 240 pages
Book Rating : 4.7/5 (543 download)

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Book Synopsis Proceedings 2021 Joint AAZV EAZWV Conference by : Charlotte Kirk Baer

Download or read book Proceedings 2021 Joint AAZV EAZWV Conference written by Charlotte Kirk Baer and published by BoD – Books on Demand. This book was released on 2021-08-31 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt: These are the proceedings of the 2021 Joint American Association of Zoo Veterinarians and European Association of Zoo and Wildlife Veterinarians Conference.

Knee Fractures

Author : Marc Hanschen
Publisher : Springer Nature
ISBN 13 : 3030817768
Total Pages : 293 pages
Book Rating : 4.0/5 (38 download)

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Book Synopsis Knee Fractures by : Marc Hanschen

Download or read book Knee Fractures written by Marc Hanschen and published by Springer Nature. This book was released on 2021-11-30 with total page 293 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a complete overview of the various types of fractures around the knee. Each chapter addresses anatomical key features, surgical procedures, postoperative regimes and complication strategies. International knee experts discuss how to improve osteosynthesis techniques as well as pearls and pitfalls for each type of knee fracture. Current clinical outcomes are included throughout and the authors recommend their preferred therapeutic approach and salvage measures if required. Knee Fractures is an essential, go-to resource for orthopaedic surgeons dealing with the total spectrum of simple and complex knee fractures in daily clinical practice.