MINISTRY OF THE HIGHER AND SECONDARY VOCATIONAL EDUCATION REPUBLIC OF UZBEKISTAN
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN TASHKENT MEDICAL ACADEMY
The vice rector on study
prof. Teshayev O. R. _______
«___» __________ 2012г.
Chair: Traumatology orthopedics, VGTH with neurosurgery.
Subject: Traumatology orthopedics.
For medico-preventive faculty
On a subject: Surgical methods of treatment in traumatology and orthopedics. Reparativny regeneration of a
bone fabric.
SRS-of Feature of fractures of bones at children.
Practical occupation No. 3
TECHNOLOGY OF TRAINING
TASHKENT-2012
Practical occupation No. 3
On a subject: Surgical methods of treatment in traumatology and orthopedics. Reparativny regeneration of a
bone fabric.
SRS-of Feature of fractures of bones at children.
1. Subject and equipment venue
- chair of traumatology orthopedics, VPH with neurosurgery and audiences,
- office of emergency traumatology of the 2nd clinic of TMA,
- thematic patients or volunteers, patient's records, surgical tools, scenarios of role-playing games, visual aids,
distributing materials, banners, video and photographic material.
- new investment technological technologies,
2. Time of carrying out occupations
225минут (5 class periods).
3. Occupation purpose. To acquaint students with existing methods
operative fixing bone отломков at changes of bones,
indications and contra-indications to the operation, existing types
metalwork and ways of their use. Will study stages
reparativny regeneration of a bone fabric.
4. Pedagogical tasks:
- to fix the general ideas of concept an osteosynthesis;
- to fix and make metal construction definition about concept;
- to create knowledge types of methods of an osteosynthesis; - to acquaint students with features of contraindications of carrying out surgical treatment;
5. Results of educational activity
The student should know:
- to make definition of concept an osteosynthesis;
- to make definition of concept of a metal construction;
- nobility of methods of an osteosynthesis;
- to know contra-indications to carrying out surgical treatment.
The student should be able:
To carry out practical skill - rendering of the first medical care at an open fracture of bones of a forearm.
6. Methods and equipment of training
Case.
7. Tutorials.
- Manuals, video and photographic material, books
- Educational матерялы, X-ray pictures, educational films, plait, plaster material
8. To form of education.
Individual work, work in groups, collective.
9. Training conditions
The audience having conditions for work in groups.
10. Mannitoring and estimates.
- Oral control: control questions, performance of educational tasks in groups.
- Written control: control questions.
Technological card of educational occupation.
Content of activity
Work stage
Teacher
The I stage
Introduction
educational
occupation
(10 mines)
5 minutes
Students
1.1. Calls an occupation subject, its purpose, tasks Listen
and planned results of educational activity.
–
Write down
in
Independently
study
1.2. Acquaints with an operating mode on occupation contents of a case and
and criteria of an assessment of results (see individually fill a leaf of the
methodical instructions for students).
analysis of situations.
1.3. Explains appointment a case-stadi and its
influence on development of professional knowledge.
1.4. Раздаёт case materials also acquaints with a
situation analysis algorithm (see methodical
instructions for students).
1.5. Gives a task independently to carry out the
analysis and to bring results in «A leaf of the analysis
of a situation».
II stage
2.1. Carries out quiz on purpose to make active
knowledge being trained on a subject:
Answer questions.
- features of inspection of patients with diseases the
ODE;
- features of inspection of patients with damages the
ODE;
- concept about diagnostics of injury of bones;
- concept about diagnostics of injury of joints;
- idea of a traumatism on production;
- measures of prevention of a traumatism on
production;
2.2. Divides students into groups.
Reminds work rules in group and ruled discussions.
2.3. Gives a task:
To carry out and discuss results of individual work
with a case (sheets of the analysis of a situation) in
mini-groups;
Share on groups.
To estimate and choose optimum options of actions
for measures of prevention of a traumatism on
production;
To be prepared for presentation.
Change
2.4. Coordinates, advises, directs educational activity.
Checks and estimates results of individual work:
sheets of the analysis of a situation.
2.4. Coordinates, advises, directs educational activity.
Checks and estimates results of individual work:
sheets of the analysis of a situation.
Carry out an educational
task.
2.5. Will organize presentation following the results
of the done work on the solution of a case, discussion
and a vzaimootsenka.
Change
2.6. Makes comments, pays attention to the actions
chosen in the course of the analysis for measures of
prevention of a traumatism on production.
2.7. Reports the version of the decision.
Main 30 minutes.
Groups hold presentation of
results of work. Participate in
discussion, ask questions,
estimate.
2.8. Will organize performance by students of Measurement of relative and
absolute length of the
practical skills
bottom extremity
Phisical examination of patients
III stage final and 3.1. Sums up to occupation, generalizes results of Listen
educational activity, declares estimates individual and
estimated
collaboration.
10 minutes.
3.2. Emphasizes value a case stage and its influence
on development of future expert.
Express the opinion
3.3 Gives homework.
Write down
11. Motivation
Carrying out this occupation gives the chance to the student to familiarize with concepts of an osteosynthesis, a
metal construction, to existing methods of fixing bone отломков, stages of reparativny regeneration of a bone
fabric and its methods of optimization.
12. Intersubject and intra subject communications
Training of students to this subject, is based on knowledge of human anatomy, topographical anatomy and
operative surgery, anesthesiology resuscitation, sheathe surgeries.
13. Content of occupation
13.1. Theoretical part.
The osteosynthesis is a surgical connection bone отломков in the various ways.
Osteotomiya operative section (crossing) of a bone.
Transplantation of a bone is the change of the various bone fabrics applied to filling of formed defects in bones
(after removal of good-quality tumors).
Joint operations are subdivided into two groups:
1. Interventions on soft fabrics of a joint: an arthrotomy – joint opening, a sinovektomiya – an issecheniye of an
articulate bag, plastic of the sumochno-copular device.
2. Operation on the bones forming a joint.
Joint resection – an issecheniye of the articulate ends of the bones struck with any pathological process.
Arthroplastics – mobility restoration in a joint.
Arthrodesis – artificial creation of an immovability of a joint.
Big distribution was received by methods vneochagovy kompressionny Ilizarov, Gudushauri, VolkovOganesyan, Kalnberz's osteosyntheses \devices.
Phases of a cycle of restoration of a bone:
The first phase – the beginning of development of a reproduction and a proliferatsiya of cellular elements under
the influence of products of a necrosis and некробиоза the damaged cages and fabrics. Major importance in
formation of a bone callosity has blood circulation restoration in the field of a change.
The second phase – education and a differentiation of fabric structures. It is characterized by a progressing
proliferatsiya and a differentiation of cellular elements that occurs thanks to anabolic hormones. Young bone
cages form an organic basis bone регенерата. Under optimum conditions the osteoidny fabric is formed.
The third phase – formation of bone structure. The main process is the complete recovery of blood circulation in a
place of a change and a mineralization of an albuminous basis регенерата. The space between отломками bones
is filled with a melkokletochny network bone трабекул from a coarse-fibered and lamellar bone fabric. By the
phase end bone balochka merge in compact substance with wide bone channels.
The fourth phase – reorganization primary регенерата and a bone restitution. In this stage the accurate
kortikalny layer is defined, the marrowy channel is restored, the nadkostnitsa is accurately differentiated. The
chaotic arrangement of obyzvestvlenny structures is replaced by their orientation, a superfluous naplastovaniye
регенерата.
General regularities of reparativny bone regeneration
Reparativny regeneration of a bone fabric — formation of a bone fabric on a place of injury of the bone, directed
on its high-grade structural функцио nalny restoration.
Feature of bone reparativny regeneration — a mnogoetapnost of its current at which each subsequent stage
happens a consequence previous. From the moment of injury of a bone before reparation end, i.e. formation of a
morph of logically mature bone fabric filling defect and connecting bone отломки, and achievements of highgrade restoration of functions of a bone as itself stoyatelny body there passes a lot of time. Thus the general
regularities of a course of reparativny process of a bone fabric and the specific features depending on conditions
of its current, potentialities of osteogene cellular elements, and also from a condition of all organism are distinctly
traced. The general regularities of reparativny process in the injured bone and its end, occurring in optimum
conditions, are presented in a look своеоб different "generalized character". Optimum conditions mean a simple
closed fracture of a long tubular bone, the correct repozitsiya and good fixing bone отломков.
The damage stage, or primary destruktsiya, usually happens кратковре mine, but its extensiveness depends on an
injuring factor (in the case under consideration - mechanical character): its forces, duration and areas step game.
At most often met closed fracture of a long tubular bone there is a violation of its integrity to division into two
bone отломка (distalny and proximal). Are thus broken off a nadkostnitsa, эндост, a bone fabric and all elements,
in them present and with them connected: fibrous (collagenic and elastichesky) and cellular (фибробласты,
остеобласты, osteocytes, cages predecessors) elements, a marrow, blood and lymphatic vessels, nerves, the
fabrics surrounding a bone.
Thus, the trauma causes a destruktsiya of fabric elements in the field of damage, violation of interrelation of the
remained fabric elements and change of fabric spatial very tectonics. It follow fiziko-chemical and biochemical
changes of the environment in a damage zone, I initiate shchy new (other) structural changes.
Stage of consequences of primary destruktsiya, secondary destruktsiya. As a result of alteration in the center of
damage the tsiya develops inflammatory реак. Its first sign — the blood-groove and limfoobrashcheniye
frustration connected with a vazodilatatsiya and being accompanied by increase of permeability of a vascular wall
therefore there is an ekssudatsiya, i.e. an exit from vessels in a fabric of water, proteins, salts and blood cells.
Thereof arises swelled surrounding fabrics. In the center of an inflammation find metabolism products, toxins. It is
followed лейкодиапедез, i.e. by migration of leukocytes and an infiltratsiya them to it, surrounding the
inflammation center. The inflammatory giperemiya, a-ism няются rheological properties of blood develops, there
are стазы, local hemorrhages, thrombosis of small vessels, a fibrinozny exudate. As a result of a metabolic
disorder in the center of an inflammation acidosis, a hypoxemia and hyper osmium develop. In резуль тате
leykotsitarny reaction in the center there is a large amount of enzymes that causes disintegration of the damaged
fabrics. Between bone отломками обра зуется a blood clot. At a change of a kortikalny part of a diaphysis there
is a rupture of the vessels passing in the central channels остеонов that brings to пре to blood-groove dyeing on
them on some depth from damage border to a place of their next branching or анастомоза with vessels adjacent
остеонов.
13.2. Analytical part
METODICHESKYE RECOMMENDATIONS AND TECHNOLOGY OF CARRYING OUT
GAMES «BEE SWARM»
For work it is necessary:
1. A set of options of tasks and the situational tasks which have been unpacked on single sheets.
2. Nomerki for lot on number of students in each subgroup.
3. Blank sheets, papers, handle.
Work course:
1. All students of a subgroup together discuss a task. The general time of game - 45 minutes.
2. All students of group share lot on 3 subgroups on 4 students in everyone.
3. Each subgroup sits down at a separate table, prepares a sheet of paper and the handle.
4. On a leaf date, group number, faculty, a full name, participating students of the entitled subgroup and business
game is written.
5. One of students of each subgroup takes option of a task which is used for all subgroups from an envelope.
6. One of students of each subgroup copies a task on a leaf.
7. In them writes down its decision.
8. On the solution of a task 15 minutes are taken away.
9. The teacher observes, behind a game course.
10. On the expiration of operating time are given to the teacher.
11.Все participants of game discuss results, choose most
the correct decisions for which there is the maximum point. 12. For discussion 15 minutes are taken away. 13.
Students receive for answers from a rating of theoretical hours
occupations. 14. The subgroup which gave the most right answers, receives
the maximum point-100 of % from a rating of a theoretical part of occupation. 15. On a leaf with the answer the
teacher puts points and the list. 16. The point got by students is considered at exposure an assessment
current occupation. 17. In the lower free part of the magazine the mark about carrying out becomes
games by the signature of the head of group. 18. Works of students remain the teacher.
13.2.1. Situational tasks:
1-situational task
At you is on reception sick in the L. 72 years. The impossibility to lift an extremity complains of pains in the right
coxofemoral joint. From the anamnesis: in 2 hours prior to receipt fell at home from a chair to the right side. At
survey external rotation of the right bottom extremity, a symptom of «the stuck heel» is noted. Active bending in
a coxofemoral joint are impossible, passive are painful. Sensitivity of skin of an extremity and a pulsation on
peripheral arteries are kept.
• Your preliminary diagnosis
• What help you render?
• You will carry out what additional methods of research?
• Types of an osteosynthesis at this pathology?
2-situational task
You have on reception a patient And. 22 years. Strengthening of pains at movements complains of pains, a
swelling in the right knee joint. From the anamnesis: in 20-30 minutes prior to receipt fell at a bus stop. At survey
the increase in volume of a circle of the right knee joint in relation to healthy is noted. At a palpation the
kripitatsiya is defined. Sensitivity of skin of an extremity and a pulsation on peripheral arteries are kept.
• Your preliminary diagnosis
• What help you render?
• You will carry out what additional methods of research?
• Types of an osteosynthesis at this pathology?
3-situational task
At you is on reception of the patient Д 34 years. Complains of pains amplifying at movements and a swelling in
the right hip. From the anamnesis: for 30 mines before receipt fell from a bicycle. At survey the increase in
volume of a circle of the right hip in relation to a healthy hip is noted. At a palpation severe pain is defined.
Sensitivity of skin of an extremity and a pulsation on peripheral arteries are kept.
• Your preliminary diagnosis
• What help you render?
• You will carry out what additional methods of research?
• Types of an osteosynthesis at this pathology?
13.2.2 Practical part
Practical skill - First-aid treatment at an open fracture of bones of a forearm.
Purpose: To master equipment of first-aid treatment at an open fracture of bones of a forearm.
Equipment: Volanter, couch, aseptic napkins, Kramer's tire, bandage.
Carried-out stages (steps).
№
Actions
Stages
It is not
executed (0
points)
It is completely
correctly
executed
1.
Introduction аналгетика.
0
20
2.
Antibiotic introduction
0
20
3.
Imposing of an aseptic bandage.
0
20
4.
Extremity immobilization Kramer's tire
0
20
5.
Transportation in a hospital.
0
20
In total
14. Forms of control of knowledge, skills and abilities.
- the oral;
- the written;
- situational tasks;
- to show abilities of performance of practical skill.
100
15. Criteria of an assessment of the current control on a subject: «Surgical methods of treatment in traumatology
and orthopedics. Reparativny regeneration of a bone fabric»
№
Progress in (%) and points
Assessment
Level of knowledge of the student
Depending on a situation can make the
correct decision and sums up. By
preparation for a practical training uses
additional literature (as on native, and in
English) Independently analyzes essence of
a problem of surgical methods of treatment
in traumatology and orthopedics and
reparativny regeneration of a bone fabric.
Can independently examine the patient
and correctly makes the diagnosis (at
treatment of changes and dislocations).
1
2
96-100
Shows high activity, a creative approach at
carrying out interactive games.
3
91-95
Independently analyzes essence of a
problem of surgical methods of
treatment
in
traumatology
and
orthopedics
and
reparativny
regeneration of a bone fabric. Shows
high activity, a creative approach at
carrying
out
interactive
games.
Correctly solves situational problems,
proves treatment, makes the plan, tells
surely. Has exact representations on an
etiology, патогенезу, to clinic, can
carry out differential diagnostics, to
appoint treatment, can carry out
prevention in
traumatology and
orthopedics. Practical skill carries out
surely, understands essence
Correctly collects the anamnesis,
examines the patient, makes the
preliminary diagnosis. Can interpret
data of laboratory researches. Actively
participates in SRS discussion.
4
86-90
Shows high activity at carrying out
interactive games.
Correctly solves situational problems,
but can't appoint concrete treatment,
tells surely. Has exact representations on
an etiology, патогенезу, to clinic, can
carry out differential diagnostics, to
appoint treatment, but can't carry out
prevention at treatment of changes and
dislocations.
Practical skill carries out on steps.
Correctly collects the anamnesis,
examines the patient, makes the
preliminary diagnosis. Can interpret
data a laborator ny researches. Actively
participates in SRS discussion.
6
Correctly solves situational problems, is
able to make the clinical diagnosis on
classification, but can't appoint the plan
of treatment and preventive actions, tells
surely. Has exact representations on an
etiology, патогенезу, to clinic and to
carry out differential diagnostics, but
can't appoint treatment. Practical skill
carries out, but confuses steps. Correctly
collects the anamnesis, examines the
patient,
makes
the
preliminary
diagnosis. Can interpret data of
laboratory
research.
Actively
participates in SRS discussion.
7
Correctly solves situational problems,
but can't prove the clinical diagnosis,
tells surely. Has exact representations on
an etiology, патогенезу and clinic, but
can't carry out differential diagnostics
and to appoint treatment.
Correctly collects the anamnesis,
examines the patient, but can't estimate
weight of a condition. Can partially
interpret data of laboratory research.
Actively participates in SRS discussion.
8
Commits mistakes at the solution of
situational tasks (can't expose the
diagnosis on classification). Knows
clinic at inspection of patients by
scoliosis and acquired deformations,
tells
not
surely.
Has
exact
representations on an etiology of
changes
and
dislocations,
and
reparativny regeneration of a bone
fabric, but can't connect clinic with the
patogenezy. Collecting the anamnesis
not purposeful, survey not according to
the scheme. Can't interpret data
laborator-ny researches. It is passive at
SRS discussion.
Имеет общие представления о
методов лечения в травматологии и
ортопедии
и
репаративной
регенерации
костной
ткани,
рассказывает не уверенно, путает.
9
Самостоятельно не может опросить и
осмотреть больного. Не может
интерпретировать
данные
лабораторных исследований. Не
участвует в обсуждении СРС
10
76-80
Has no exact representation of the basic
principles of treatment of changes and
dislocations.
Doesn't know a subject.
11
71-75
For presence of the student on
occupation, in due form, itself has
writing-books, a phonendoscope
16. SRS-of Feature of fractures of bones at children.
Control questions
1. At children you know what features of fractures of bones?
2. What is when children's changes occurs on type of «a green branch»?
3. Why at newborns and children of chest age diagnostics is complicated?
17. Control questions
1. Types of surgical treatment.
2. Osteosynthesis methods.
3. Complications at surgical treatment.
4. Indications to surgical treatment.
5. Contra-indications to surgical treatment.
6. Types of a metalwork.
7. Stages of reparativny regeneration?
8. Methods of optimization of reparativny regeneration?
18. Recommended literature
1. Yumashev G. S. «Traumatology and orthopedics of» M «, Medicine» 1990. - 575с.
2. Musalatov H.A. «Traumatology and orthopedics of» M «, Medicine» 1995. - page.
3. «Instructions on field surgery» V.N.Byalin, L.N.Bisenkov, P.G.Bryusov, etc. M 2000. - 415с.
4. www.ejbjs.org www.traumatic.ru
www/bone-surgery.ru