DOCSLIB.ORG

(SEMINAR) LESSON Academic Discipline

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
(SEMINAR) LESSON Academic Discipline METHODICAL RECOMMENDATIONS FOR INDIVIDUAL WORK OF STUDENTS DURING PREPARATION TO PRACTICAL (SEMINAR) LESSON Academic discipline Surgical stomatology Module № 6 Topic of the lesson №15 Gunshot and non-gunshot damage of upper and lower jaws. Orthopedic and surgical treatments. Course V Faculty International (Stomatological) Poltava 1. Relevance of the topic: One of the important problems of modern oral surgery there are a clinic, diagnosis, treatment and prevention of damage to the maxillofacial region, particularly fractures of the lower jaw, which is the highest percentage of all the facial and neck injuries in peacetime. This is associated with a significant increase in the frequency of road accidents, domestic trauma, the use of different types of knives and the growth of street crime and tensions in society. The study of the subject will allow the future doctor is clearly focused on issues clinics, diagnostic methods of first aid to victims the trauma of the lower jaw, in the subsequent practice will avoid many complications primarily related to improper conduct of the doctors in the early stages of providing assistance (late diagnosis, poor and part-time emergency aid). 2. THE SPECIFIC AIMS: 1. Methods оf diagnostics and first aid at ballistic, not ballistic damages of upper and lower jaws. 2. Methods of diagnostics at damages of bones of upper and lower jaws. 3. The help at damages of bones of upper and lower jaws. 4. X-ray diagnostics at damages of bones of upper and lower jaws. 5. Treatment of damages of bones of upper and lower jaws. 3. BASIC KNOWLEDGE, ABILITIES, SKILLS, WHICH ARE NECESSARY FOR STUDY THEMES (intradisciplinary integration) Names of the The received skills previous disciplines 1. Ethics. To establish into psychological contact to the patient. 2. The organization To apply knowledge of principles of the organization of of public health the help at damages of the facial skeleton. To draw up the services. necessary documentation. 3. Pathological To describe character of pathological changes at damages morphology. of the facial skeleton. 4. Pathological To define the aetiology and pathogenesis of raumatic physiology. conditions. 5. Propaedeutics of To write the scheme of the general inspection of the internal illnesses. patient. To make the examination of the patient. 6. General surgery. To describe principles of diagnostics and treatment damages of bones of facial skeleton To prescribe the circuit of inspection of the patient. 4. Tasks for independent work in preparation for the lesson 4.1. The list of the basic terms, parameters, characteristics which the student should master at preparation for employment: Term Definition Combined is physical, thermal, and/or chemical trauma combined with trauma radiation exposure at a dose sufficient to diminish the likelihood of overall survival or functional recovery. Complex trauma Demages of two and more organs and areas. 4.2. Theoretical questions to lesson: 1. Types of surgical methods of treatment of non-bullet fractures of lower and upper jaw. 2. Definition of a concept “direct and indirect osteosynthesis”. 3. Types of direct osteosynthesis, indications and contra-indications, method of operative interference. 4. Types of indirect osteosynthesis, indications and contra-indications, method of operative interference. 5. Modern methods of surgical treatment of non-bullet fractures of lower and upper jaw (mini plates, transplantates, contour osteoplastics etc.). 6. Mistakes and complications during and after application of surgical methods of treatment of non-bullet fractures of lower and upper jaw. 4.3. Practical works (task) which are executed on lesson: 1. To be able to collect anamnesis from a patient. 2. To be able to examine the patient. 3. To be able to prescribe additional examination methods. 4. To be able to read laboratory data. 5. To be able to read x-rays foto of the head. 6. To be able to carry out a differential diagnosis. 7. To know how to write a medical card. 8. To be able to spend splinting of the patient. THE CONTENT OF THE TOPIC: Complete fractures of the mandible can be divided according to their anatomical location into seven main types. These are: 1. Condylar 2. Coronoid 3. Ramus 4. Angle 5. Body (molar and premolar areas) 6. Symphysis and parasymphysis 7. Multiple and comminuted fractures Fractures in each of these situations have clearly denned signs and symptoms which can be readily elicited even in cases of multiple injury. Condylar fractures These are the most common fractures of the mandible and are the ones most commonly missed on clinical examination. Condylar fractures may be unilateral or bilateral and they may either involve the joint compartment as intracapsular fractures or the condylar neck when they are regarded as extracapsular. The latter are the more common. The extracapsular fracture may exist with or without dislocation of the condylar head, and the upper fragment may either remain angulated on the lower portion of the ramus or be displaced medially or laterally. The commonest displacement is antero-medial owing to the direction of pull of the lateral pterygoid muscle, which is attached to the antero-medial aspect of the condylar head and also to the meniscus of the temporo-mandibular joint. In the immediate post-traumatic phase most fractures in the condylar region exhibit similar signs and symptoms. Unilateral condylar fractures Inspection Any movement of the lower jaw is likely to be restricted and painful. There is often swelling over the temporo-mandibular joint area and there may be haemorrhage from the ear on that side. Bleeding from the ear results from laceration of the anterior wall of the external auditory meatus, caused by violent movement of the condylar head against the skin in this region. In the normal subject the close relationship of the condyle to the skin of the external auditory meatus can be appreciated if the little finger is placed within the external ear and the jaw moved. It is important to distinguish bleeding originating in the external auditory canal from the more serious middle ear haemorrhage. The latter signifies a fracture of the petrous temporal bone and may be accompanied by cerebrospinal otorrhoea. In all cases of suspected condylar fracture the ear should be examined carefully with an otoscope. The appearance may be extremely confusing even to an experienced maxillofacial surgeon, and there should be no hesitation in asking the opinion of an otologist in these circumstances. The haematoma surrounding a fractured condyle may track downwards and backwards below the external auditory canal. This gives rise to ecchymosis of the skin just below the mastoid process on the same side. This particular physical sign also occurs with fractures of the base of the skull, when it is known as «Battle's sign». It is vital not to confuse the aetiology when an ecchymosis at this site is discovered On the very rare occasion when the condylar head is impacted through the glenoid fossa, the mandible will be locked and middle ear bleeding may present externally. If the condylar head is dislocated medially and all oedema has subsided due to passage of time, it may be possible to observe a characteristic hollow over the region of the condylar head, but in the immediate post-traumatic phase this physical sign is obscured by oedema. Palpation In the recently injured patient there is invariably tenderness over the condylar area. When post-traumatic oedema is present it is difficult to palpate the condylar head and what is believed to be the condylar head may, in fact, be that portion of the condylar neck continuous with the lower portion of the ramus. It may be possible to determine whether the condylar head is displaced from the glenoid fossa by palpation within the external auditory meatus. Standing in front of the patient both little fingers can be hooked into each external auditory meatus and the position and movement of each condylar head compared. Intra-oral. Displacement of the condyle from the fossa or over-riding of the fractured condylar neck shortens the ramus on that side and produces gagging of the occlusion on the ipsilateral molar teeth. The mandible deviates on opening towards the side of the fracture and there is usually painful limitation of protrusion and lateral excursion to the opposite side. Bilateral condylar fractures The signs and symptoms already mentioned for the unilateral fracture may be present on both sides. Overall mandibular movement is usually more restricted than is the case with a unilateral fracture. Intra-orally It only requires one condyle to be displaced with shortening of the ramus to lead to premature contact of the posterior teeth on the side of injury. Accordingly derangement of the occlusion is more usual with bilateral than with unilateral condylar fractures. Intracapsular fractures produce little if any shortening and the occlusion is often found to be normal. If both fractures have resulted in displacement of the condyles from the glenoid fossa or overriding of the fractured bone ends, an anterior open bite is found to be present. In all cases of bilateral fracture there is pain and limitation of opening with restricted protrusion and lateral excursions. Bilateral condylar fractures are frequently associated with fracture of the symphysis or parasymphysis and these areas should always be carefully examined. Fracture of the coronoid process This is a rare fracture which is usually considered to result from reflex contraction of the powerful anterior fibres of the temporalis muscle. The fracture can be caused by direct trauma to the ramus but is rarely in isolation in these circumstances. If the tip of the coronoid process is detached, the fragment is pulled upwards towards the infratemporal fossa by the temporalis muscle. The coronoid process is sometimes fractured during operations on large cysts of the ramus. This is a difficult fracture to diagnose clinically but there may be tenderness over the anterior part of the ramus and a tell-tale haematoma.
Load more

Recommended publications
  • Treatment of Common Hip Fractures: Evidence Report/Technology
    This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007 10064 1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. Evidence Report/Technology Assessment Number 184 Treatment of Common Hip Fractures Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. HHSA 290 2007 10064 1 Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota Investigators Mary Butler, Ph.D., M.B.A. Mary Forte, D.C. Robert L. Kane, M.D. Siddharth Joglekar, M.D. Susan J. Duval, Ph.D. Marc Swiontkowski, M.D.
    [Show full text]
  • Osteoarthritis Epidemiologicosteoarthritis and Genetic Aspects Epidemiologic and Genetic Aspects
    From the Department of Orthopedics, Clinical Sciences From the DepartmentLund University, of Orthopedics, Lund, Sweden Clinical Sciences Lund University, Lund, Sweden Osteoarthritis EpidemiologicOsteoarthritis and genetic aspects Epidemiologic and genetic aspects Jonas Franklin Jonas Franklin Thesis 2010 Thesis 2010 Contact address Jonas Franklin Department of Orthopedics Akureyri University Hospital IS-600 Akureyri Iceland E-mail: [email protected] ISSN 1652-8220 ISBN 978-91-86443-87-0 Lund University, Faculty of Medicine Doctoral Dissertation Series 2010:71 Printed in Sweden Mediatryck, Lund 2010 To Hlíf Atli Egill and Jóhann Jonas Franklin 1 Contents List of papers, 2 Radiographic techniques, 17 Radiographic classification, 17 Definitions and abbreviations, 3 Statistical methods, 17 Thesis at a glance, 4 Ethics, 18 Description of contributions, 6 Data encryption and protection of the individual, 18 Introduction, 7 Symptoms and signs of osteoarthritis, 7 Summary of results of papers I-V, 19 Natural history of osteoarthritis, 8 Discussion, 24 Radiographic features of osteoarthritis, 8 Research methodology, 24 Definition of osteoarthritis, 9 Abnormal mechanical loading is a risk factor for Definition of hip fractures, 9 OA, 25 Study methodology, 9 Natural history of OA, 27 Epidemiology of osteoarthritis, 11 OA and hip fracture, 28 Epidemiology of hip fractures, 11 Conclusions, 30 Risk factors for osteoarthritis ,12 Summary, 31 Risk factors for hip fracture, 13 Populärvetenskaplig sammanfattning på Aims, 14 svenska, 33 Patients and methods, 15 Ágrip á íslensku, 35 Overview of patient/subject allocation, 15 Acknowledgements, 37 Patient identification, 15 References, 38 Populations examined, 16 2 Osteoarthritis - Epidemiologic and genetic aspects List of papers This thesis is based on the following papers: I.
    [Show full text]
  • Single Screw Type of Lag Screw Results Higher Reoperation Rate in the Osteosynthesis of Basicervical Hip Fracture
    Journal of Orthopaedic Science xxx (xxxx) xxx Contents lists available at ScienceDirect Journal of Orthopaedic Science journal homepage: http://www.elsevier.com/locate/jos Original Article Single screw type of lag screw results higher reoperation rate in the osteosynthesis of basicervical hip fracture * Jung-Taek Kim a, Yong-Chan Ha b, Chan-Ho Park c, Jun-Il Yoo d, Tae-Young Kim e, a Ajou University Hospital, Department of Orthopaedic Surgery, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea b Chung-Ang University, College of Medicine, Department of Orthopaedic Surgery, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea c Yeungnam University Medical Center, Department of Orthopedic Surgery, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea d Gyeongsang National University Hospital, Department of Orthopaedic Surgery, 79, Gangnam-ro, Jinju, Gyeongsangnam-do, 52727, South Korea e Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea article info abstract Article history: Background: Basicervical hip fractures are relatively rare with greater biomechanical instability Received 8 January 2019 compared to the other types of hip fractures. Several studies have reported ambivalent surgical outcomes Received in revised form of basicervical hip fractures. The purpose of this multicenter study was to analyze surgical outcomes of 7 February 2019 basicervical hip fractures according to the fixation type of proximal femur and lag screw type. Accepted 12 February 2019 Methods: Among 3220 hip fractures, 145 were classified as basicervical hip fractures. Of those, 106 Available online xxx patients treated with osteosynthesis were included to analyze the surgical complications according to fixation type of proximal femur: sliding hip screw(SHS) and cephalomedullary nail (CMN) groups.
    [Show full text]
  • Extracapsular Hip Fractures—Aspects of Intramedullary and Extramedullary Fixation
    D 990 OULU 2008 D 990 UNIVERSITY OF OULU P.O.B. 7500 FI-90014 UNIVERSITY OF OULU FINLAND ACTA UNIVERSITATIS OULUENSIS ACTA UNIVERSITATIS OULUENSIS ACTA SERIES EDITORS DMEDICA Ismo Saarenpää ASCIENTIAE RERUM NATURALIUM IsmoSaarenpää Professor Mikko Siponen EXTRACAPSULAR HIP BHUMANIORA FRACTURES—ASPECTS OF University Lecturer Elise Kärkkäinen CTECHNICA INTRAMEDULLARY AND Professor Hannu Heusala EXTRAMEDULLARY DMEDICA Professor Olli Vuolteenaho FIXATION ESCIENTIAE RERUM SOCIALIUM Senior Researcher Eila Estola FSCRIPTA ACADEMICA Information officer Tiina Pistokoski GOECONOMICA University Lecturer Seppo Eriksson EDITOR IN CHIEF Professor Olli Vuolteenaho PUBLICATIONS EDITOR Publications Editor Kirsti Nurkkala FACULTY OF MEDICINE, INSTITUTE OF CLINICAL MEDICINE, DEPARTMENT OF SURGERY, DIVISION OF ORTHOPAEDIC AND TRAUMA SURGERY, ISBN 978-951-42-8933-0 (Paperback) UNIVERSITY OF OULU ISBN 978-951-42-8934-7 (PDF) ISSN 0355-3221 (Print) ISSN 1796-2234 (Online) ACTA UNIVERSITATIS OULUENSIS D Medica 990 ISMO SAARENPÄÄ EXTRACAPSULAR HIP FRACTURES—ASPECTS OF INTRAMEDULLARY AND EXTRAMEDULLARY FIXATION Academic Dissertation to be presented, with the assent of the Faculty of Medicine of the University of Oulu, for public defence in Auditorium 1 of Oulu University Hospital, on November 7th, 2008, at 12 noon OULUN YLIOPISTO, OULU 2008 Copyright © 2008 Acta Univ. Oul. D 990, 2008 Supervised by Professor Pekka Jalovaara Reviewed by Docent Peter Lüthje Docent Jari Salo ISBN 978-951-42-8933-0 (Paperback) ISBN 978-951-42-8934-7 (PDF) http://herkules.oulu.fi/isbn9789514289347/ ISSN 0355-3221 (Printed) ISSN 1796-2234 (Online) http://herkules.oulu.fi/issn03553221/ Cover design Raimo Ahonen OULU UNIVERSITY PRESS OULU 2008 Saarenpää, Ismo, Extracapsular hip fractures—aspects of intramedullary and extramedullary fixation Faculty of Medicine, Institute of Clinical Medicine, Department of Surgery, Division of Orthopaedic and Trauma Surgery, University of Oulu, P.O.Box 5000, FI-90014 University of Oulu, Finland Acta Univ.
    [Show full text]
  • Posters, Which Were Displayed on All Orthopaedic Wards and Emailed Individually to All Orthopaedic Trainees and Consultants
    Abstract no.: 36413 PATHOLOGICAL INFLUENCES OF CONNECTIVE TISSUES DYSPLASTIC DISORDERS ON SURGICAL TREATMENT RESULTS OF PECTUS EXCAVATUM IN CHILDREN Iskandar KHODJANOV, Sherali KHAKIMOV, Khatam KASYMOV Scientific Research Institute Traumatology and Orthopedics, Tashkent city (UZBEKISTAN) Recently, several complications associating with the instability of the installed bar, PC deformity occurrence and the PE relapse have been occurred in more than 20% after surgery. Purpose was the determination of the role of the connective tissues dysplastic disorders for remodeling processes of the anterior chest wall in children with PE in post- operative periods. Investigation performed on 40 children, who underwent operative treatment by the D. Nuss procedure in Clinic of SRITO RUz, with PE. Genetic assessment was carried out by the T. Milkovska-Dmitrova and A. Karakeshev classification (1985). Good results were obtained in 35 cases in the nearest postoperative periods, 5 cases were with the severe pain and in long-term periods was occurred the PC deformity in 2 cases, secondary atypical deformation in 1, the relapse of PE till I degree in 1 and in 1 case was saved the neuralgic pain. The connective tissues dysplasia is a congenital character genesis, characterized by metabolic disorders in the stroma tissues and several enzymopathy. The osseo-cartilaginous structural system growth processes were not behavioral in the necessary age norm of locomotors apparatus and with the delaying of ossification processes also in the adolescent's age and the sterno-costal complex became most pliable. These changes complicated the correction method of PE, extended the period of immobilization. It is hard to determine the outcome operative results of the patients with severe degrees of conjunctive tissues dysplasia.
    [Show full text]
  • Case Files Orthopaedic Surgery
    CASE FILES® Orthopaedic Surgery Eugene C. Toy, MD Timothy T. Roberts, MD Vice Chair of Academic Affairs, Resident of Orthopaedic Surgery Department of Obstetrics and Division of Orthopaedic Surgery Gynecology Albany Medical Center The John S. Dunn, Senior Academic Albany, New York Chair and Program Director The Methodist Hospital Ob/Gyn Joshua S. Dines, MD Residency Program Orthopaedic Surgeon Houston, Texas Sports Medicine and Shoulder Service Clerkship Director, Clinical Professor Hospital for Special Surgery Department of Obstetrics and Gynecology New York, New York The University of Texas—Houston Assistant Professor of Orthopaedic Surgery Medical School Weill Cornell Medical College Houston, Texas New York, New York Andrew J. Rosenbaum, MD Resident of Orthopaedic Surgery Division of Orthopaedic Surgery Albany Medical Center Albany, New York New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by McGraw-Hill Education, LLC. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-179029-1 MHID: 0-07-179029-2 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-179030-7, MHID: 0-07-179030-6. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefi t of the trademark owner, with no intention of infringement of the trademark.
    [Show full text]
  • Correlation Between Hip Osteoarthritis and Proximal Femoral Fracture Site: Could It Be Protective for Intracapsular Neck Fractures? a Retrospective Study on 320 Cases
    Osteoporosis International (2019) 30:1591–1596 https://doi.org/10.1007/s00198-019-05015-5 ORIGINAL ARTICLE Correlation between hip osteoarthritis and proximal femoral fracture site: could it be protective for intracapsular neck fractures? A retrospective study on 320 cases Tommaso Maluta1 & Giovanna Toso1 & Stefano Negri1 & Elena Manuela Samaila1 & Bruno Magnan1 Received: 24 February 2019 /Accepted: 13 May 2019 /Published online: 8 June 2019 # International Osteoporosis Foundation and National Osteoporosis Foundation 2019 Abstract Summary Proximal femoral fractures affect elderly people, showing high morbidity and mortality incidence resulting in a major economic burden on national healthcare systems. Understanding the causes of these injuries is of paramount importance to prevent the serious consequences of these fractures. Introduction Hip osteoarthritis and proximal femoral fractures mainly affect elderly patients. Several authors, in their studies, tried to document a correlation between these conditions, but the results are conflicting. The aim of this study was to evaluate the relationship between hip osteoarthritis and the fracture site. Secondly, to evaluate if the grade of osteoarthritis could influence the fracture pattern. Methods A retrospective study on 320 patients admitted for hip fracture between June 2015 and December 2016 was carried on. Radiographic images were evaluated, assessing the type of fracture, presence and grade of osteoarthritis according to Kellgren- Lawrence and Tönnis classifications, and their correlations. Results Osteoarthritis was found to affect the fracture site showing a higher prevalence among subjects with extracapsular than those with intracapsular fractures (p < 0.00001). Patients with radiographic signs of arthritis had mainly trochanteric fracture. Conversely, patients without arthritis more frequently presented a femoral neck fracture.
    [Show full text]
  • Differences in Mortality Among Hip Fracture Patients in the Swedish Fracture Register
    Differences in mortality among hip fracture patients in the Swedish Fracture Register Master Thesis in Medicine Author: Lars Söderström The Sahlgrenska Academy: Programme in Medicine Gothenburg, Sweden 2018 Supervisors: Alicja Bojan, MD, PhD & Michael Möller, MD, PhD Sahlgrenska University Hospital, Department of Orthopaedics Sahlgrenska Academy, University of Gothenburg Table of contents ABSTRACT .............................................................................................................................. 3 ABBREVIATIONS .................................................................................................................. 5 BACKGROUND ...................................................................................................................... 6 INTRODUCTION ....................................................................................................................... 6 EPIDEMIOLOGY ....................................................................................................................... 7 HIP FRACTURES AND SURGICAL TREATMENT .......................................................................... 8 Fracture classification ..................................................................................................... 8 Müller AO/ASIF Classification ........................................................................................ 9 Intracapsular fractures .................................................................................................. 11 Extracapsular
    [Show full text]
  • A Treatise on Fractures in the Vicinity of Joints, and on Certain Forms Of
    J' J^JJJ ^4WHI»*»— ' riHiM ——————— : ; ; In the Tress, and nearly ready, Fifth Edition, Fcp. 8w., THE DUBLIN DISSECTOR, OE MANUAL OF ANATOMY; COMPKISING A CONCISE DESCRIPTION OF THE BONES, MUSCLES, VESSELS, NERVES, AND VISCERA ALSO, 'Eiiz wlatibc Unatomg of tj^c liiffctcnt i^cgiong of t^c l^timan 23olig FOR THE USE OF STUDENTS IN THE DISSECTING-ROOM. By ROBERT HARRISON, M. D. New Edition, illustrated by upwards of 150 Engravings. PART L^ANATOMY OF THE MUSCULAR SYSTEM. Chap. I. Dissection of the external Parts op the Head and Face External Parts of the Head ; Dissection of the external Parts of the Face ; Vessels and Nerves of the Face. Chap. II Dissection of the Neck—Of the Muscles ; Dissection of the Vessels and Nerves of the Neck; of the Mouth, Pharynx, and Larynx; of the Pharynx; of the Palate and its Muscles ; of the Larynx ; of the deep Muscles of the Neck. Chap. Ill Dissection of the Thorax—Of the Muscles on the anterior and lateral Parts of the Thorax ; Dissection of the AxiUa ; of the Cavity of the Thorax. Chap, IV. Muscles of the Back. Chap. V Dissection of the upper Extremity Dissection of the Muscles of the Shoulder and Arm ; of the Fore-arm and Hand. Chap. VI Dissection of the Abdomen Of the Muscles on the anterior and la- teral Parts of the Abdomen; Dissection of the Viscera of the Abdomen; of the Vessels and Nerves of the Abdomen ; Dissection of the Kidney and Ureters ; of the deep Muscles of the Abdomen; of the Perinaeum in the Male ; of the Pelvis ; of the Organs of Generation in the Male.
    [Show full text]
  • It, and Is Very Satisfactory in Its End-Result. Complications, As
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by ZENODO and bandage only makes a bad matter worse, the materially in differentiating the variety and location vessels and nerves being compressed between bone of the fracture. The major or direct causes almost and board. That which is absolutely essential to invariably cause the extracapsular variety of frac¬ thoroughly satisfactory répair, is early and complete ture with or without impaction, while the minor or adjustment. This is one of the few fractures in which indirect cause produces intracapsular fracture. the chief difficulty lies in securing not maintaining Symptoms.—In all cases of suspected fracture of apposition. Once secured, only the simplest after- the neck of the femur, the entire person, from the treatment is really required ; a band around the wrist anterior superior spinous process of the ilium to the perhaps, to lessen the after-spreading due to separa¬ toes, with the exception of the external genital or¬ tion of and later somewhat misplaced attachment of gans which can be protected from view by a napkin, the inter-articular cartilage. should be exposed to inspection. After the clothing In view of possible after-ligation, as professional has been removed above the pelvis we are at once en¬ opinion is now, it is wiser as a rule to employ some abled to see the relationship of the two opposite tro- form of splint, plaster-of-paris or other, never extend¬ chanters to each other, their corresponding appear¬ ing below the wrist line and thus supporting the ance, their relative prominence.
    [Show full text]
  • Guidelines to Compliment the Integrated Care Pathway for Hip Fracture
    Guidelines to compliment the Integrated Care Pathway for Hip Fracture Contents Pre-hospital care ED Management Blue Book Standards for hip fracture care Analgesia/ Pain Supplementary oxygen/ hypoxaemia Anaesthesia/ Fasting Consent/ Mental capacity Delirium Falls & fractures Role of Occupational therapist Pre-hospital care HIPS- Acronym for pre-hospital management H - Hydrate the patient if required, dehydration increase confusion and complicates patient assessment. There is some evidence that poorly addressed dehydration in the initial period of injury and prior to surgery may contribute to increased mortality in the early days I - Immobilisation of the fracture using simple means such as padding and triangular bandages and where necessary in association with Vacuum mattresses is all that is required. In addition prevention of chilling is also a key initiative. P - Pain management that is sub-optimal increases mortality and morbidity. In a number of studies effective pre-hospital pain management has been shown to be in the order of 50%. We need to put more emphasis on the role of analgesia for these patients. NSAID medications are relatively contra-indicated. S - Specific facilities that can offer prompt intervention to repair the fractures offer these patients the best level of care. Transporting patients to an ED that cannot offer surgical management necessitates a secondary transfer and delays care. This is not to the benefit of the patient and places a demand on the Ambulance Service to provide secondary transport, possibly delaying definitive care further. National Ambulance Service 2014 Emergency Department Management British Orthopaedic Association/ British Geriatric Association Blue Book Standards 1) All patients with hip fractures should be admitted to an acute orthopaedic ward within 4 hours of presentation.
    [Show full text]
  • Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Neck of Femur in the Elderly
    DOI: 10.7860/JCDR/2019/26357.12914 Original Article Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Orthopaedics Section Neck of Femur in the Elderly TEJASVI BHATIA1, ANIL JUYAL2, RAJESH MAHESHWARI3, AtUL AGRAWAL4, DIGVIJAY AGARWAL5 ABSTRACT Results: The male to female ratio was 1:2.75. The mean age of Introduction: Intertrochanteric fractures account for 50% of patients was 73.4±8.64 years (range 60-97 years). Thirty patients all fractures of the proximal femur, the average age of incidence were operated with DHS blade and followed up for a minimum being 66 to 77 years. Dynamic Hip Screw (DHS) fixation is of six months. Pre-operatively, the patients were categorised considered to be one of the standard treatments of trochanteric as per Singh’s Index; 66.7% (20 cases) were in Grade 3 while fractures. The most common mode of failure with the DHS is cut- 33.3% (10 cases) fell in Grade 2. out of the screw which significantly relates to the bone mineral Postoperatively, the average Tip Apex Distance (TAD) was density of proximal femur. DHS blade was developed in an attempt 21.66 mm (range 18-28 mm), 25 cases (83.3%) had TAD <25 mm. to enhance anchorage of the implant in the osteoporotic bone. Neck-shaft angle of the contralateral hip was measured for Aim: To assess the radiological and functional outcome of comparison. No change in neck-shaft angle was observed in extracapsular fracture neck femur in osteoporotic patients 21 cases (70%) however varus collapse more than 4° was seen treated with DHS blade.
    [Show full text]