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, MFS with neurosurgery.
Subject: Traumatology orthopedics.
For medico-preventive faculty
On a subject: Fractures of bones of a basin
Practical occupations No. 12
TASHKENT-2012
Practical occupation No. 12
Subject Injury of bones of a basin
1. Subject and equipment venue.
- Traumatology orthopedics, VPH with neurosurgery;
- For carrying out practical skills: X-ray pictures, distributing materials, photo
and video.
- New technological grants.
2. Duration of studying of a subject
225 minutes (5 class periods)
3. Occupation purpose
To acquaint students with the main injuries of bones of a basin, principles
rendering of the first medical care, to inspection methods, types of anesthesia, immobilization principles. To
train students in skills of interpretation a X-ray of pictures, local anesthesia of a place of a change.
4. Pedagogical tasks
– classification injury of bones of a basin;
- clinic at injury of bones of a basin;
- to fix knowledge of inspection methods;
- to fix general idea about rendering of the first medical care;
- to deepen concepts about main types of anesthesia;
- to systematize knowledge of immobilization principles;
- to fix skills of interpretation a X-ray of pictures
5. Results of educational activity.
The student should know:
- classification and types of fractures of bones of a basin
- the main clinical signs at fractures of bones of a basin
- principles of rendering of the first medical care;
- inspection methods, types of anesthesia and immobilization.
Should be able
To carry out practical science:-rendering of the first medical care at a fracture of bones
basin.
6. Methods and technicians of training.
Project.
7. Tutorials.
- Traumatology orthopedics, VPH with neurosurgery;
- For carrying out practical skills: X-ray pictures, distributing materials, photo and
video;
- New technological grants.
8. Forms of education
Individual work, work in groups, collective.
9. Training conditions
The audience having conditions for work in groups.
10. Monitoring and assessment
- Oral control: control questions, performance on a subject test questions, organizers, interactive games.
- Performance of practical skills.
Technological card of educational occupation
Work stage
Content of activity
teacher
The I stage
Introduction
educational
occupation
(10 mines)
Students
– 1.1. Calls an occupation subject, its purpose, tasks Listen
in and planned results of educational activity.
Write down
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.
5 minutes
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:
Make change definition?
Make dislocation definition?
You know what basic principles of treatment of a
change and dislocations?
You know what methods of a conservative method
of treatment of changes and dislocations?
List complications of a conservative method of
treatment of changes and dislocations?
2.2. Divides students into groups.
Reminds work rules in group and ruled discussions.
2.3. Gives a task:
Answer questions
To carry out and discuss results of individual work
with a case (sheets of the analysis of a situation) in
mini-groups;
To estimate and choose optimum options of actions Share on groups.
for a conservative method of treatment of changes
and dislocations;
To be prepared for presentation.
Change
Carry out an educational
task.
2.4. Coordinates, advises, directs educational activity.
Checks and estimates results of individual work:
sheets of the analysis of a situation.
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 a conservative
method of treatment of changes and dislocations.
2.7. Reports the version of the decision.
Groups hold presentation of
results of work. Participate in
discussion, ask questions,
estimate.
Main 30 minutes.
2.8. Will organize performance by students of Measurement of relative and
absolute length of the
practical skills
bottom extremity
Examination of patients
III stage final and 3.1. Sums up to occupation, generalizes results of Measurement of relative and
educational activity, declares estimates individual and absolute length of the
estimated
collaboration.
bottom extremity
10 minutes.
3.2. Emphasizes value a case-stadi and its influence
on development of future expert.
3.3 Gives homework.
11. Motivation.
Carrying out this occupation gives the chance to the training will seize the basic principles of rendering of the
first medical care, inspection, types of anesthesia, immobilization principles, interpretation a X-ray of pictures
to make the preliminary diagnosis and to define further tactics of maintaining the patient.
12. Boundaries subject and inside subject communications
Training of students on this subject, is based on knowledge of human anatomy, topographical anatomy and
operative surgery, radiology, anesthesiology resuscitation and sheathe surgeries.
13. Content of occupation
13.1. Theoretical part
Changes of a basin arise at its sdavleniye in the sagittalny or face-to-face plane. Such conditions are created at
a sdavleniye between buffers of cars, a wall and moving transport, at collapses and blockages, falling from
height, road accidents (arrival of vehicles on the pedestrian), etc.
Changes of forward department of a basin are most frequent. The pelvic ring compressed over limits of its
elasticity, breaks in the thinnest and weak places - the top and bottom branches of pubic and sciatic bones.
Unilateral changes are in most cases observed. At changes of branches of pubic and sciatic bones отломок has
the butterflies form and it is displaced кзади.
If the trauma is considerable and force is attached not only to area симфиза, but also to wings of a
podvzdoshny bone, there is a rupture of the copular device of a podvzdoshno-kresttsovy joint. In some cases
in back department of a pelvic ring there is a fracture of a podvzdoshny bone.
Under the influence of reduction of a podvzdoshno-lumbar muscle, a square muscle of a waist and slanting
muscles of a stomach at vertical changes of a forward and back half ring of a basin the external ("torn-off")
part of a basin is displaced up.
Basin compression on a diagonal causes a change of a pelvic ring: on one party in forward department - a
fracture of pubic and sciatic bones, on other party behind - the vertical rehouse of a podvzdoshny bone.
Falling from height on sciatic hillocks can lead to emergence of a unilateral or bilateral vertical change of a
basin and a splintered change of sciatic hillocks.
Changes of a vertluzhny hollow and the central dislocation of a hip arise at a basin sdavleniye sideways, when
falling on a big spit or as a result of a strong direct stroke.
Separated changes of a peredneverkhny awn of a podvzdoshny bone, sciatic hillock arise at run, game in
football and other cases sudden and not the koordinirovanny movement causing strong reduction of muscles
more often.
Classification of changes of a basin
From the practical point of view it is convenient to use A.V. Kaplan's classification - L.G. Shkolnikova:
1. Regional changes - fractures of a wing of a podvzdoshny bone, a kresttsovo-podvzdoshny joint, a tailbone, a
sciatic hillock, separations of awns of a basin.
2. Fractures of bones of a pelvic ring without violation of its continuity: fractures of one or both lonny or sciatic
bones, changes on the one hand lonny, on the other hand - a sciatic bone.
3. Fractures of bones of a pelvic ring with violation of its continuity:
• forward department – bilateral changes of both branches of a lonny bone; bilateral fractures of a lonny and
sciatic bone; gaps симфиза.
• back department – a vertical fracture of a podvzdoshny bone or a sacrum, a rupture of a kresttsovopodvzdoshny joint;
• changes of forward and back departments of a basin with continuity violation only forward or only a back
half ring or at the same time in both departments. This group of changes treat:
• a change Malgenya - a fracture of lonny and sciatic bones on the one hand and a vertical fracture of a
podvzdoshny bone from the same party;
• Vualemye's change - a vertical change of a sacrum and a forward half ring of a basin, as at a change
Malgenya, from the same party;
• a change Niderlya (a diagonal change of a basin) - a vertical fracture of a podvzdoshny bone on the one hand
and a forward half ring - with another;
• Dyuverney's change - a change of a back half ring with a change of a vertluzhny hollow.
4. Changes of a vertluzhny hollow - changes of edge or a hollow bottom, the central dislocation of a hip.
5. Changes of a basin and damage of pelvic bodies.
6. The combined damages.
First aid and treatment
At patients of 1 and 2 groups on Kaplan's classification - Shkolnikova the general condition isn't broken more
often. Some of them can come to an appointment independently. Patients with a separation of the front and
top awn of a basin go a back forward. It is so-called «a symptom of reverse motion». More often patients with
these damages don't need emergency actions of the first medical assistance. The main method of their
treatment – conservative: make anesthesia of a place of a change and the patient stack on rigid (with a
wooden board) a bed in the situation "frogs". The confinement to bed remains within 4-6 weeks. During this
period appoint LFK and FTL-protsedury for the fastest restoration of impellent activity. Work capacity it is
restored 8-10 weeks later.
Patients of 3-6 groups at receipt in a specialized hospital almost always demand urgent actions of medical
assistance which are foreseen in office of intensive therapy more often.
Assistance to this group of victims should be begun with carrying out antishock therapy and a stop of internal
bleeding in the available ways.
New pedagogical techniques used on this occupation: «brain storm».
METHOD USE «BRAIN STORM»
For work on this technique it is necessary to establish the trust atmosphere, to overcome psychological
tension as a hindrance to open discussion. The technique unites ability to expand a thinking stereotype, to
abstract from existing restrictions, to develop dynamism of cogitative activity, to intensify educational activity.
The method learns to give reason, defend own point of view, to find the optimum decision, to build
communication, to convince others of fidelity of an otstaivayemy position.
The technique provides:
- a greeting of soaring of thought, considering that than the idea is more unusual, they it is better than
subjects;
- receiving the greatest number of offers;
- combination of ideas and their development;
- any remarks and critical statements which disturb formation of ideas;
- short statements without the developed argument;
- division of group into those who generates ideas and those who processes them.
The clinic of injuries of bones of a basin is offered to students. Everyone states the offers which register on a
board. Then serially open the provision of a template and are compared with answers of students. At the end
the assessment of correctness of performance of a task and summarizing is carried out.
Template of answers. Clinic and diagnostics at a basin change
- The pose of the victim is typical: feet are slightly bent in knee and coxofemoral joints, taken away and
ротированы кнаружи (situation "frogs").
- At a palpation on available basin departments (pubic, sciatic bones, a crest of a wing of a podvzdoshny bone)
there is a pain strengthening.
- Positive symptom Verneylya: strengthening of pain in a change place at a basin sdavleniye for wings of
podvzdoshny bones.
- Larrey's positive symptom: pain arises in deeply located pelvic bones in attempt to develop pelvic bones for
the front and top awns.
- The same important symptom at the majority of changes of a basin is violation of an oporosposobnost of
extremities. The symptom of "the stuck heel" quite often comes to light, as well as at changes of a proximal
part of a hip.
- The size of shifts of a basin at changes decides on violation of a continuity of a forward and back half ring by a
way: distance measurements from top of a mechevidny shoot of a breast to the front and top awn of a basin
or to a top of one of anklebones.
- First aid at injuries of bones of a basin: anesthesia, Volkovich's positions.
- What method is made at injuries of bones of a basin: on Shchkolnikovu-Selivanov.
- Fixing term at changes of forward department of bones of a basin: 6 weeks.
- Fixing term at changes of a vertluzhny hollow: 12 weeks.
- Term of disability of patients at changes vertluzhny vpadiny:-9 months.
13.2. Analytical part
1-situational tasks
The sick N, 31 years, fell from a balcony of the fourth floor. A condition the heaviest, it is adynamic, the
expressed pallor of integuments, pulse 120 1 minute, a blood pressure of 65/40 mm Hg, a stomach it is
moderately intense, at a palpation it is painful in the bottom departments. A palpation and a basin sdavleniye
from sides painfully. On the roentgenogram of bones of a basin the fracture of lonny and sciatic bones is
determined by the butterflies type (with violation of a continuity of a pelvic ring).
• Your preliminary diagnosis.
• Main methods of research.
• VOP tactics
• With what diseases it is necessary to make differential diagnostics
2-situational tasks
It is taken from under the turned-over lorry. Complains of severe pains in the bottom of a stomach and in the
field of a basin. Feet are slightly developed кнаружи. Integuments pale, on a forehead of a droplet of sweat.
Tachycardia. Pulse of weak filling. Air temperature +5оС.
• Your preliminary diagnosis
• Main methods of research
• With what diseases it is necessary to make differential diagnostics
• VOP tactics
3-situational tasks
The patient of 26 years arrived concerning an open fracture of the right hip. Wound PHO, an osteosynthesis by
a pin CYTO is made. The Koksitny bandage with a window in the field of a wound. For 4 days the condition of
the patient worsened. Complains of intensive holding apart pains in a wound, sleeplessness. Eyforichen. It is
pale, features were pointed. Tones of heart deaf, pulse of weak filling 118 уд.в minute. Hell of 100/70 mm hg.
Temperature 38.8. Hip sharply edematous, integuments of pale yellow color. Round a wound dark (bronze)
stains. Seams, a wound dry are dismissed. Muscles bulked up, are stuck out outside. When pressing the wound
leaves gas vials.
• Your preliminary diagnosis
• Main methods of research
• With what diseases it is necessary to make differential diagnostics
• VOP tactics
13.2.2 Practical part
Rendering of the first medical care at a fracture of bones of a basin.
Purpose: rendering of the first medical care at a fracture of bones of a basin.
Equipment: Patient, couch, matrasny roller, bandage.
Carried-out stages (steps).
№
Actions
(0 points)
It is
completely
correctly
executed
It is not
executed
Stages
1.
Put the victim on a rigid stretcher or a wooden board a
back down.
0
20
2.
To feet give halfbent situation.
0
20
3.
Under knees put dense rollers from clothes, blankets, etc.
0
20
4.
At a change of forward department of a basin apply a ring
fixing bandage
0
20
5.
Enveloping bandage (For stabilization)
0
20
In total
100
14. Forms of control of knowledge, skills and abilities
1. - the oral;
2. - the written;
3. - situational tasks;
4. - to show abilities of performance of practical skill.
15. Criteria of an assessment of the current control on a subject: «Open changes. Traumatic osteomyelitis»
№
Progress in (%) and points
Mrk
Level of knowledge of the student
1
96-100
Depending on a situation can make the
correct decision and sums up. By
preparation for a practical training uses
additional literature. Independently
analyzes essence of a problem at treatment
congenital deformations of the
musculoskeletal device. Can independently
examine the patient and correctly makes
the diagnosis (congenital to deformation of
the musculoskeletal device). Shows high
activity, a creative approach at carrying out
interactive games. Correctly solves
situational problems with complete
justification of the answer. During SRS
discussion actively asks questions, does
additions
2
91-95
By preparation for a practical training uses
additional literature (as on native, and in
English). Independently analyzes essence of
a problem of the basic principles at
treatment congenital deformations of the
musculoskeletal device. Can independently
examine the patient and correctly makes
the diagnosis (congenital to deformation of
the musculoskeletal device). Shows high
activity, a creative approach at carrying out
interactive games. Correctly solves
situational problems with complete
Excellent
«5»
justification of the answer. During SRS
discussion actively asks questions, does
additions. Practical skill carries out surely,
understands essence.
3
Independently analyzes essence of a
problem at treatment congenital
deformations of the musculoskeletal
device. Shows high activity, a creative
approach at carrying out interactive games.
Correctly solves situational problems,
proves treatment, makes the plan of
preventive actions. Knows, 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.
86-90
Shows high activity at carrying out
interactive games.
4
76-80
6
Correctly solves situational problems, but
can't appoint concrete treatment, confuses
dosages of preparations. Knows, 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
congenital deformation of the
musculoskeletal device.
71-75
Good
«4»
7
66-70
Correctly solves situational problems, but
can't prove the clinical diagnosis. Knows,
tells surely. Has exact representations on
an etiology, патогенезу and clinic, but can't
carry out differential diagnostics and to
appoint treatment.
8
61-65
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.
satisfactorily «3»
Has the general representations about
treatment methods in traumatology and
orthopedics, tells not surely, confuses.
Can't independently interrogate and
examine the patient. Can't interpret data of
laboratory researches. Doesn't participate
in SRS discussion
9
55-60
10
54 -30
Unsatisfactorily«2»
Has no exact representation of the basic
principles treatment congenital
deformation of the musculoskeletal device.
Doesn't know.
11
20-30
Unsatisfactorily«2»
For presence of the student on occupation,
in due form, itself has writing-books,
manuals.
17. Control questions
1. Classification and types of fractures of bones of a basin.
2. Mechanism of damage of fractures of bones of a basin
3. Indications to treatment to skeletal vytyazheniye.
4. Rational choice of a method of treatment of changes.
5. Rendering of the first medical care.
6. Clinic at injuries of bones of a basin.
7. By what damages it is combined at fractures of bones of a basin.
18. Recommended literature
1. Yumashev G. S. «Traumatology and orthopedics of» M «, Medicine» 1990. – 575с.
2. Musavatov H.A. «Traumatology and orthopedics of» M «, Medicine» 1995. – page.
3. A. V.Kaplan «Injuries of bones and joints» Moscow «Medicine> 1979. - 568с.
4. WWW.ejbjs.org
WWW.jbjs org.uk
WWW.traumatic.ru
WWW.trauma.bd.ru