MINISTRY OF EDUCATION OF THE REPUBLIC OF UZBEKISTAN
HEALTHMINISTRY OF THE REPUBLIC UZBEKISTAN
TASHKENT MEDICAL ACADEMY
“Approved”
Vice-Rector O.R. Teshaev ____
«___»____________ 2012y
DEPARTMENT OF TRAUMATOLOGY-ORTHOPEDICS, NEUROSURGERY AND
MILITARY-FIELD SURGERY
Subject: Children traumatology
FOR 7TH YEAR STUDENTS OF MEDICAL FACULTY
COMMON METHODIC SYSTEM
For practical lesson on theme:
FEATURES OF THE LOW EXTREMITY, SPINE & PELVIS INJURIES IN CHILDREN
TRAINING TECHNOLOGY
Tashkent – 2012
Compiled by:
- Head of the Department of Traumatology-Orthopaedics, military-field surgery
with neurosurgery, Tashkent Medical Academy, M.D. Karimov M.Y.
- Ph.D. Ibragimov D.I., Ph.D.HodjaevSh.Sh.
Reviewers:
LESSON №2
Theme:FEATURES OF THE LOW EXTREMITY, SPINE AND PELVIS INJURIES IN
CHILDREN
Time of classes: 6 hours
Form of lesson
Structure of the lesson
Purpose of the activity
The student should know
Students:8-10
Practice
1.Introduction
2. Theory
3.Analytic part
- Organizer
- Tests
- Situational problems
4. Practical part
To familiarize students to correctly diagnose, treat and
assist the various types of damage. Teach practical skills in the
transportation immobilization of bone injuries of the lower
extremities apply casts, splints and reduce a carry differential
diagnosis with other injuries, and referrals.
Classification and types of fractures hip, leg, foot, pelvis and spine;
The main clinical signs of bone fractures hip, leg, foot, pelvis and
spine;
The principles of first aid;
Survey methods, types of anesthesia and immobilization
Perform practical skills - overlay technique of the cast, with fractures
of hip, leg, foot, pelvis and spine in orthopedic trauma patients.
Self-differentiate various types of fractures, and able to be sent to
the hospital.
Impose a transport bus with fractures of the lower extremities,
Transported in the correct position and skill in injuries of the pelvis
and spine.
Languet prepares and applies them in simple fractures.
Prepare a functional bed for treatment of injuries of the pelvis and
spine.
Learn the techniques of stretching through the axilla loop of injured
spinal column
The student should be able
to
Pedagogical objectives:
- trained
in
the
clinical
assessment of children with
spinal cord injuries;
- teach methods of anesthesia
for pelvic injury;
- to teach the principles of
transport immobilization in
trauma
of
the
lower
extremity.
Training methods
Training form
Training tools
Place of training
Monitoring and evaluation
Justification of the theme
Conducting the lesson allows students to get acquainted
with the basic principles of first aid, survey methods, types of
anesthesia, immobilization principles, interpreting X-ray images
of local anesthesia the fracture site, making plaster casts,
overlay langetnyh and circular plaster casts, the delivery of
preliminary diagnosis and identification of further tactics of the
patient.
Interactive group discussions and individual forms,
"Brainstorm", organizers, supervision, case studies
Collective work in a group, to suit the individual
Graphic organizers, flip charts, markers
Auditorium, designed for training
Recitation: quiz, written survey: tests, tasks
Technologic map of the lesson
Stages
of training
and time
6 hours
1st stage
Introduc
tion to the
lesson
10 min
5 min
2nd
stage
Main
Activity
Teacher
Students
1.1. The topic, its aim and expected results. Main terms of
Listen
the topic: to give the definition for etiologic, pathogenic, write
symptomatic treatment. Show the plan of the topic.
and
1.2. To give the list of literature (attachment #9)
1.3. Give live questions to taken students’ attention. It is
Listen
and
given the order of activities of organization of training write
process according to the plan and structure of the lesson.
Give answers
1.4. it is announced the evaluation criteria of students’ to the questions
activity (attachment #5)
Listen
2.1. To discuss the topic, to evaluate the knowledge of
Give
answers
part
30 min
90 min
students using new pedagogical technologies (attachment to the questions.
#2)
2.2. The private work of students for practice
Discuss,
(attachment #3)
definitional
questions
give
45 min
2.3. analyze the situation independently, express the
Discuss,
problem, define the solution and give the solutions definite,
give
(attachment #3.1)
questions
on
materials
of
Break
practical lesson.
Fill on sheet of
analyze on their
own and solve the
2.4.solve the tests on their own
problems.
( attachment 2.3).
Discuss
the
tests.
45 min
2.5.show the illustrative materials to students
(presentations, slides, videos and others) and comment
them.
15 min
Break
Present, other
students
participate
in
discussion and give
answers.
5 min
-
Venue topics and equipment
Chair: Trauma-orthopedics, military surgery with neurosurgery;
Banners, X-ray pictures, handouts, photos and video material.
1. Rationale topics
Conducting the lesson allows students to get acquainted with the basic principles
of first aid, survey methods, types of anesthesia, immobilization principles,
interpreting X-ray images of local anesthesia the fracture site, making plaster casts,
overlay langetnyh and circular plaster casts, the delivery of preliminary diagnosis
and identification of further tactics of the patient.
2. Integration between disciplines
Training students on this topic, based on knowledge of human anatomy,
topographic anatomy and operative surgery, radiology, anesthesiology and intensive
care and general surgery.
Knowledge acquired by students during school hours, to allow first aid, produce
analgesia and immobilization, to prepare a bus for the immobilization of fractured
limbs, prepare languet plaster and plaster bandages, plaster cast.
3. Components of the lesson (point)
3.1. Theoretical part
Damage in the hip is the proximal femur. This section should analyze in detail the
mechanism of these injuries clinical picture of each type of fracture and assistance.
Student under this section must know the mechanism of these injuries and
should be able to immobilize limb fractures of the proximal and diaphyseal fractures
of the femur.
Fractures of the femur are quite common and occur in the direct mechanism of
injury. Fractures of the femur are: proximal, diaphyseal and distal. Under this
section the student should know - the mechanism of injury, classification, and
possible complications should be able to - anesthetize fracture, apply a transport
bus and referred to a specialist.
If hip dislocation must know the classification of dislocation and should be able
to reduce a dislocation of the hip.
Fractures of the leg bones in children, as well as damage to the knee joint are
complex fractures.
The student needs to know the mechanism of bone fractures leg and foot and
their classification, to be able to impose a transport bus and fractures without
displacement to be able to apply a plaster cast.
The student must know the types of trauma and dislocation of bones of the leg
and foot and be able to help.
Damage of the pelvis - these compound fractures of all fractures, followed by
shock and threatens the patient's life. This section must be carefully collected
history, clinical survey and intrapelvic organs.
The student must know the examination of the patient with fractures of the
pelvis, as well as be able to arrange transportation of patients.
The student must know the classification of fractures and their analgesic and
properly lay the patient on the functional crib.
Spinal injury - a heavy form of injury, accompanied by a dysfunction of the spinal
cord. In this section, the student must know the mechanism of injury, the clinical
picture of each spine is damaged. The student should be able to examine the patient
and the immobilization of the patient to impose a transport, as well as to know the
patient laying on the bed function.
FRACTURE OF THE FEMUR
1. Clinic of the disease: Fractures accompanied by significant soft tissue damage,
blood loss and pain. Fractures of the proximal femur are divided: the medial-epi-and
osteoepifizioliz femoral head ... and basal, lateral - intertrochanteric, trans condylar.
Objective: pain localized in the fracture, a hematoma in the groin or trochanter
region, external rotation of the lower extremity, pain with axial loading, shortened
limbs, strengthening of the femoral artery pulsations (with syndrome Girgolavz) a
symptom of "sticky heels", crepitation, abnormal mobility bone fragments. Fractures
of the shaft depending on the level of fracture fractures are divided into upper,
middle and lower thirds.
2. Interpretation of laboratory and instrumental methods. In the blood picture
is often anemia due to blood loss. Radiographs in 2 projections, said the type of
fracture and displacement of bone fragments. By type of shift of medial fractures
may be valgus (angle SHDU ^ 127-130 °), varus (SHDU ^ 127-130 °).
Hip fractures in the upper third of the diaphysis of the proximal fragment
displacement characteristic forward and outward, distal - medially and posteriorly.
Fractures in the middle third - is characterized by the displacement of bone
fragments in length.
For fractures of the diaphysis of the lower third of the distal fragment is typically
offset posteriorly, proximal - inwards.
3. The differential diagnosis of injuries of soft tissue tumors.
Soft tissue injuries of the femur
Pain swelling in the area of injury
External rotation of the lower limb is missing.
Limb axis correctly, the length of the segment is
the same on both sides.
The general condition of the patient usually does
not suffer.
Radiological - no bone damage
Fractures of the femur
Pain, swelling, hemarthrosis, deformity, abnormal
mobility and crepitus of bone fragments in
fractures.
External rotation of the lower extremity.
The shortening of the limb.
Blood loss, possible anemia, fat embolism. The
patient is often in a state of shock.
Visible on X-ray line of the fracture with
displacement or without displacement of bone
fragments.
4. Standard of care. Proximal femur: skeletal traction for displacement of bone
fragments, hip cast without bias derotation gypsum high boot - palliative treatment
in older people. If necessary, surgery - open reduction with metal osteosynthesis. In
the diaphyseal fractures hip used three main methods: immobilization, functional
and operational.
Immobilization method used in the incomplete fracture of the total cross
fractures without displacement or angular displacement, are fixed at the time of
applying bandages. Immobilization for 5-6 weeks.
When unstable fractures of the hip is applied functional method of treatment
(bare-bones, sticking-plaster) extension of up to 4 weeks.With the subsequent
imposition of hip cast for 4 weeks.Children under 3 years - on Shede sticking-plaster
traction, 3-5 years - sticking-plaster traction on the bus Beller. Over 5 years - skeletal
traction.
5. Prevention of childhood injuries in preschool and school settings with teachers
and parents.
6. Rehabilitation. Begins with the first day of the patient in the hospital and
continues after discharge. From the first days make breathing exercises combined
with tilt, swivel head and body. Included are exercises to strengthen the muscles of
the shoulder belt of the upper extremities.
In post immobilization period due to restrictions of movement of the large joints
damaged legs, dizziness and general weakness, the primary goal is to raise the
general tone of the patient, strengthening the muscles of the shoulder girdle, upper
limbs and torso, training support function of a healthy foot, the movement of
patient education with the help of crutches .
Physical therapy procedures aimed at a more rapid restoration of joint function,
especially hip, knee and ankle joints. Assign paraffin baths, electrophoresis, KU 3%
on the joints of 6-8 and 10-12 procedures, respectively. In cases of insufficient bone
callus in the fracture, appoint electrophoresis CaCl 5% of 10-12 procedures.
Rehabilitation is possible after 3-4 months. Full recovery within 6 months.
DISLOCATION OF FEMUR
Clinic. Distinguish anterior and posterior dislocations of the hip, which, in turn,
are the upper and lower. There is a sharp pain in the hip. Finite fixed in a forced
situation, which depends on the type of dislocation. Active movements are not
possible. Trying to passive movements accompanied by severe pain and springy
resistance. There is a pronounced lordosis.
Interpretation of laboratory and instrumental methods. Changes in blood
picture are not typical. On anteroposterior X-ray images of hip joint is a distinct
direction of displacement of the femoral head. In the poster medial dislocation of
the upper empty acetabulum, femoral head is displaced upwards. Poster inferior
dislocation is determined by the displacement of the femoral head down to the level
of the ischium. When the obturator dislocation of the femoral head is displaced
distally and is located at the obturatorhole basin. Over loan dislocation is
characterized by a shift of the shadow of the femoral head forward and downward
from the acetabulum.
The differential diagnosis is carried out with fractures of the upper end of the
femur. Extremity fractures rotated outward, positive symptom "sticky heels," the
motion of the hip are possible but limited due to pain. X-ray inspection is the
primary method, confirming the diagnosis.
Standards of care. The patient is given anesthesia; it is desirable to relax the
muscles. Position the child on her back. Helper traction for injured lower extremity,
bending it to an angle of 135o in the hip and knee joints, and rotates more outward.
Surgeon-pressure of fingers on the greater trochanter region reduce dislocate the
femoral head in the direction of the basin.
The method of reposition of hip dislocation by Yu.Dzhanelidze. The patient was
placed on the abdomen so that the broken leg hung freely from the table. After 1015 minutes of relaxation begins hanging limbs. The surgeon flexes the patient's leg
to a right angle, holding a hand basin of the child to the table. Then devotes several
legs and rotates the patient puts his knee in the popliteal cavity sprained foot and
pulls the knee downward. In this case the femoral head is supplied to the
acetabulum and reduce a. After the control limb radiography coke fixed plaster cast
for 3 weeks.
Prevention of hip dislocation is injury prevention in general.
Rehabilitation. Remediation in the form of a period of physiotherapy is carried
out on the second day after reduction. 2 periods beginning after the removal of
dressings. During this period, strengthen trunk muscles, quadriceps and calf
muscles. Given static load with crutches on his injured leg. Motion in the hip dosing
initially excluded flight and rotary motion. Exercise therapy combined with physical
therapy, paraffin baths, and KU electrophoresis on 3% of the region of large joints to
10-12 procedures. Children, undergone hip dislocation, in need of dispensary
observation for 2 years.
FRACTURES OF THE FEMUR OF NEWBORNS
1. Clinic of the disease. On examination, is determined by the deformation of the
femoral and anxiety of the child, the leg is bent at the hip and knee joints and a few
shows due to a reflex hyper tonus flexors. On palpation of crepitus bone fragments,
abnormal motility and increased child's anxiety due to pain. Relative shortening of
limbs on the affected side.
2. Interpretation of laboratory and instrumental studies: X-rays can be seen the
level of hip fracture (usually the middle and upper thirds), the nature and type of
fracture (usually transverse or oblique), the degree of displacement of fragments,
proximal fragment usually displaced anteriorly and laterally, distal to the relevant
muscle groups - upwards and backwards.
3. The differential diagnosis is carried out with soft tissue injury in the hip area.
In the contusion crepitation of fragments, no pathological mobility. The x-ray the hip
bone changes are not determined.
4. Standard of care. Treatment consists of local anesthetic with subsequent
immobilization of the damaged limb. Treatment of choice for birth fractures of the
femur in the newborn is sticking-plaster traction in Blount or Shade. Reposition
assessed by X-ray control. The average duration of fixation is equal to 10.7 days, and
then superimposed coke cast. Up to the full consolidation of hip fracture patients to
keep on stretching.
5. Prevention of hip fracture at birth is correct, run by sparing them. It is known
that hip fractures occur more frequently in breech and transverse position of the
fetus. Hip fractures are also possible for the shaped delivery in breech presentation.
6. Rehabilitation. The outcome in most cases is good. After the removal of
traction sticking-plaster shows physiotherapy, massage, and medical gymnastics
similar in older children.
STRETCH LIGAMENTS OF ANKLE
Clinic. There is pain in the ankle, swelling and varying degrees of dysfunction. In
the first hours after the trauma the child continues to play to advance. During the
load gradually increases pain and reliance on the limb becomes impossible.
Palpation is painful, movements in the ankle joint is limited, particularly supination
of the foot and bringing out the pain.
Interpretation of laboratory and instrumental studies. Changes in blood counts
are not typical.
The x-ray the ankle in 2 projections fracture is not determined, but is seen an
increase in soft tissue.
Differential diagnosis. Sprain fracture should be differentiated from the ankles,
which are accompanied by large edema, hemorrhage and loss of support function.
The need for differential diagnosis in children younger than 13-14 years almost does
not arise, since broken ankles at this age are extremely rare. A sign of a fracture is a
sharp local pain at the pressure on the ankle side and rear and the appearance of
pain at the fracture in compression of the middle third of the tibia in the transverse
direction. Crepitation of bone fragments. The final diagnosis is established according
to the radiographs.
Standards of care.Sprain treated by immobilization and unloading. Given the
support the ankle in the medium to physiological position, the plaster bandage is
applied to languet 2-3 weeks. The first 1-2 days is applied cold to the damaged area.
After the removal of immobilization begin active and passive motion, appoint
thermal and physiotherapy to restore full function.
Prevention of child injury is closely related to the problem of education, it is
necessary to point out the importance of proper organization of children. The
challenge is to spend a reasonable leisure, parents, caregivers and teachers sent
children's interest in beneficial activities. Children organized under the supervision
of the individuals were in the special game rooms or gaming and sports venues.
Rehabilitation. Rehabilitation begins with immobilizing period (active finger
movements of the foot, the knee and hip joints, isometric tension thigh and lower
leg. In order to improve peripheral circulation and reduce swelling patients are
encouraged to periodically lower the injured leg off the bed, then giving it an
elevated position. In 3 - 5 days learn to walk with crutches.
In the period of post immobilization strengthen muscles femur and tibia, increase
mobility in the ankle joint, training muscles of the foot. Gymnastics exercises include
special exercises (back and plantar flexion of the foot, circular movements of the
foot, pronation and supination of the foot. In the early days, and then if necessary
apply the wax bath from 6 to 8 treatments and electrophoresis KU 3% for the ankle
10-12 procedures. When walking, pay attention to the proper formulation of the
feet, to develop the proper skills walking.
Labor capacity restored within 4-6 weeks.
FRACTURE OF TIBIA
1. Clinic of the disease: pain, swelling, bruising, deformity, abnormal mobility of
the fracture. The most common of diaphyseal fractures of the upper middle and
lower thirds.Violated the rotation of the foot, leg shortening.
2. Interpretation of laboratory and instrumental methods. In blood tests were
normal. On the radiograph in 2 projections specified level, the type of fracture, the
nature and type of displacement of bone fragments.
3. The differential diagnosis is carried out with soft tissue injuries in the leg.
Contusion of the soft tissues of tibia
Pain, bruising in the area of injury, limb function is
not compromised.
Segment length is not reduced.
On the radiograph in 2 projections, bone changes
are not determined.
Fracture of the tibia
Pain, hematoma, abnormal mobility, crepitation of
bone fragments. External or internal rotation of
the foot.
Shortening of leg.
On the radiograph in 2 projections determined by
the level, type and nature of the displacement of
bone fragments.
4. Standard of care. Stable fractures of the shin bones are treated with
immobilization by the imposition of the cast for a period of 2 months from the tips
of the toes to the middle of the upper thigh.
Unstable fractures of both bones of the tibia treated by the functional method of
treatment for a period of 5-6 weeks (sticking-plaster, skeletal), followed by the
imposition of the cast.
With the ineffectiveness of conservative treatment, surgical treatment is
recommended - open reduction with metal osteosynthesis.
5. Prevention of childhood injuries in preschool and school settings with teachers
and parents.
6. Rehabilitation. In period of immobilization tasks such as physical therapy, as
with other fractures. Specific exercises include finger movements of the foot, hip
and thigh muscles isometric tension and lower leg, static retention of the limb.
In post immobilization term physical therapy combined with massage, aimed at
strengthening the thigh muscles.
Physiotherapy aims to restore the function of the ankle joint in the form of
electrophoresis, KU 3% 10-12 procedures. Employability is restored within 3-4
months.
FRACTURE OF THE FOOT
1. Clinic of the disease: pain, swelling, crepitus bone fragments, the deformation
of the foot and ankle. Maximum pain to palpation at the fracture. Effleurage on the
heel causes increased pain.
2. Interpretation of laboratory and instrumental methods. Changes in blood
tests are not typical.
Radiographs in 2 projections refine the localization of fractures: talus, calcaneus.
Type of fracture is usually a cross, is the displacement of bone fragments, or the lack
thereof.
3. The differential diagnosis is carried out with soft tissue injuries of the foot,
when there are no bone lesions on radiographs.
4. Standard of care. Immobilization method is used with the imposition of the
cast, "boots" at the tips of the toes to the popliteal fossa.
Fractures of metatarsal bones with displacement - extension of the Circass-Zade
for 3-4 weeks, followed by immobilization in a plaster boots, well modeled arches.
The term of 4-6 weeks of immobilization.
5. Prevention of posttraumatic flatfoot. To this end upon application of a plaster
model of immobilization inner arch of the foot.
6. Rehabilitation. Gymnastics start in the period of immobilization. For unloading
of the foot while walking with crutches in the dressing plastered metal stirrup. The
main objective of the rehabilitation period, after removing the plaster is magnetic
therapy, massage, to restore joint movement of the foot and the strengthening of
its dome.
Individually connected physiotherapy in the form of paraffin baths 6-8
treatments, electrical stimulation leg muscles on the back surface. In instances of
post-traumatic flatfoot, insoles, arch supports are issued. Ability to work is reduced
to 4-6 months.
INTERACTIVE METHODS - "BRAINSTORMING"
The purpose of "brainstorming" - receive from a group of patients in a short time
the number of options. "Brain attack" demonstrates the knowledge of students.
Group is given the question: "Damage to the outer meniscus." Within 5 minutes of
the group members respond to a question, everything that comes into their head
and all that is written by one of the students on the board. All written, no matter
how vague, stupid, or controversial it was not.
At this time, not segregated and are not given any estimates. If the activity
subsided, the teacher can offer to write some of their ideas.
Students writes 'clinic: the nature of pain in the knee, pain in the joint gap on the
side of the damaged meniscus, aggravated during palpation, with simultaneous
rotation of tibia in the opposite direction, Baykov symptom positive symptom "click"
positive symptom Chaklin positive symptom Steiman-Buhard positive, symptom
Turner positive.
Methods: radiography, arthrography contrast.
Differential diagnosis: meniscopatie cyst meniscus damage the internal meniscus.
Treatment: surgical - meniscectomy.
Then the students along with teacher dismantle the proposal, and express
disagreement and discuss all the proposed ideas.
The question posed by the teacher:
Q: Characteristic symptoms of Baikov?
A: In the passive straightening leg torn meniscus in the presence of pain occur or
are worse.
Q: Characteristics of symptom-SteimanBuhard?
A: The appearance of pain over the damaged meniscus in the external or internal
rotation of leg, bent at an angle of 90 degrees.
Q: What is the symptom of "clicks" and symptom Chaklin?
Answer: This is one symptom - when moving the knee from the outside of the leg
rolls over the obstacle in the outer meniscus: with a click is felt.
Q: Characteristics of symptom Turner?
Answer: Hyperesthesia or anesthesia of the skin on the inner surface of the knee.
Q: What is determined by x-ray?
A: X-ray determined the presence of patella fractures or other breaches of the
knee.
Question: What is meniscopathya?
Answer: Meniscopathya - degenerative changes in cartilage meniscus.
Q: Does pain relief?
Answer: If there is pain management is carried out depending on the age of local
or general.
Q: What else needs in terms of treatment?
A: After the operation is placed upon a pneumatic bandage for several hours with
measured compression.
3.2. Part of topic analysis
Tests
1. How to treat patients with fractures of the anterior half-ring basin?
a) In the position Volkovych
b) Codivilla's extension
c) plaster cast
d) sticking-plaster traction
e) on a hammock
2. In what condition are those with damage Malgeniy?
a) A shock
b) inhibited
c) Satisfactory
d) unconscious
e) active
3. Types of the medial femoral neck fracture
a) Epifiziolizis femoral head
b) fracture of the greater trochanter
c) small trochanter fracture
d) trochanter fracture of both
e) subtrochanteric fracture
4. The reason for a long medial fusion of hip fracture
a) There is no periosteum
b) extraarticular fracture
c) fracture ramming
d) often oblique fracture
e) comminuted fracture
5. Symptom anterior dislocation of the hip
a) A leg rotated outwards and flexed at the hip
b) pain in the hip
c) No movement of the hip
d) leg medially rotated
e) all answers are correct
6. In uncomplicated spinal cord injury pain which mainly occur?
a) A localized pain
b) pain emanating from the roots
c) segmentar
d) symptom Razdolsky
e) Wiring pain
7. What clinical symptoms are observed in uncomplicated lesions spine?
a) A symptom of Silenus
b) symptom Razdolsky
c) symptom Davis
d) symptom-ShchetkinBljumberg
e) symptom of "electric bell"
8. In which the patient is carried out in closed thrust uncomplicated Spina
Bifida?
a) sitting
b)
c)
d)
e)
lying
standing
at walking
with skeletal traction
9. When common symptom of "sticky heel"?
a) A broken edge iliac
b) fractured spine iliac
c) pubic bone fracture
d) fracture ischium
10. When the symptom Lozinski occurs?
a) A fracture of the iliac region
b) fracture ischium
c) pubic bone fracture
d) fractured spine iliac
e) acetabular fracture
11. What is a fracture Malgeniya?
a) A pubic fractures, ischium and divide the sacroiliac joint
b) fracture of both pubic bones
c) fracture of both bones of the sciatic
d) symphysis gap
e) rupture of the sacroiliac joint
Answers: 1 – a; 2 – c; 3 – a; 4 – d; 5 – c; 6 – c; 7 – a; 8 – d; 9 – d; 10 – a; 11 – c.
4. ANALYTIC PART
4.1. Graphic organizer
4.2.
KNOW
• Fracture of diaphisis of
femur
WILL
KNOW
• First aid in fracture of
diaphisi of femur
HAVE
KNOWN
• Effective immobilization, prevention of
complications
• Transportation under the control of
medical person, in many cases it must
be carried out measures against the
shock
Situational case
A boy 12 y.o. hit his right thigh against a stone when he was playing football. He
stood up by himself, but felt strong pain in the right thigh and the presence of
curvature of the right thigh. The patient addressed to policlinics after that, when he
noticed that the pain is intensified during the motion up to immobilization.
Objective: it is determined the deformation of the right thigh with axis disorder
of extremity. The thigh is shortened. on palpation of thigh at level of upper third it is
determined retraction and continuity disorder of the bone, in addition to shift of
head of femoral bone. The sensitivity of fingers and peripheral circulation are intact.
Additional information to the case studies
St
ep
1
2
3
4
5
(for teachers)
Necessary set of actions performed by the student
Receiving patient in the study GPs (used non-verbal and verbal skills of interpersonal
communication). Carefully collected complaints (major: pain in the righthip, a sharp
increase in pain when walking).
Carefully collected history of the disease and find out the beginning and over: the
above complaint connects with a football game.
Learned the history of life
Risk factors (uncontrolled: age; managed: in school, strict control of the gym teacher
of Physical training). Identified the problem of the patient: a study - hip injury
Started physical examination (the student must demonstrate the correct and
consistent study of the patient with the appropriate syndrome).
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
Preliminary diagnosis - Closed fracture of the right hip
(Category 2).
Plan Survey (Students need to plan a survey of the patient):
- Determining respiratory rate (Category 3.1);
- Palpation of the hip (Category 3.1);
- Measurement of blood pressure (Category 3.1);
- Complete blood count, urinalysis (Category 3.1);
The student must justify and explain the purpose of the study.
Independently carried out the necessary amount of research in MRA:
- Finding of axe of lower extremity
- Measure of hip diameter
- Measurement of blood pressure
- CBC
- Urinalysis
(student must demonstrate to perform almost all the stages of skill with
simultaneous interpretation of the data.)
After a comprehensive survey of student demonstrates knowledge of the treatment
of objective laboratory and instrumental data (from the student requires a qualitative
analysis of the data and the conclusion).
Differential diagnosis of a closed fracture of the right hip and Galeazzi’s fracture, as
well as contusion of hip (rightly refers the patient to a consultation with a specialist.)
The final diagnosis - Closed fracture of the right hip. (category 2)
(student must coordinate your final diagnosis with a specialist).
On his return from the patient consultation or hospitalization GPs:
• reassess the patient's condition (it is made with the final diagnosis of disease, phase
of activity, the flow on the basis of professional judgment or discharge summary);
• collects data from the patient or his relatives on the recommendations of the
designated non-medicated, and treatment with medicines;
• the indications to perform or repeat a series of laboratory and instrumental studies
to determine the further tactics.
Determine the form in which the prevention of patient needs (D-IIIB). Inform the
patient and discuss the practical steps the relevant type of prevention.
Amended and recommended continuation of non-drug treatment:
• Half-bed rest;
• «Breathing Exercises";
• A balanced diet (strict compliance energy value and the mineral composition of the
diet of the organism's age, enriching the diet products containing calcium and
magnesium, the inclusion in the diet of fresh fish);
• Use regular permissible exercise control exercise physiologist;
• The rational mode of study and recreation;
Explained to the patient whether to keep (if necessary) medication, indicating dose,
time, and duration of the multiplicity of medications.
Currently, the treatment of rib fractures use fortified with vitamin D calcium
supplements, mucolytics, antibiotics
PREFERRED CHOICE PRODUCTS
UNDER CERTAIN CONDITIONS
1
7
1
8
1
9
2
0
1
Vigantolindrops
2
Coughsyrups
Set a date and time of follow-up visit the patient in the joint venture or SVP for
feedback.
The student has identified a group of follow-up and briefed about the purpose of
medical examination of the patient (group D IIIB):
Starting from the time of the fracture, the patient should be under regular
surveillance. The frequency of inspection depends on the nature of the fracture,
localization dynamics of the processes of bone formation.
The main therapeutic recreational activities at clinical examination of patients with a
fracture of the forearm are:
 Training in a healthy lifestyle;
 Physical therapy and exercise therapy in the Department of Rehabilitation;
 Improvement in the sanatorium (spa treatment).
Turning to the observers, the student demonstrates the theoretical knowledge and
practical steps of all kinds of prevention (primary, secondary, tertiary).
Turning to the observers, the student demonstrates the theoretical knowledge and
practical steps on stage clinical examination of the respective disease.
Additional information to the case studies

(forstudents)
Those obtained in the pre-hospital study number 2
• BMI - 32
• Abdominal circumference - 56
• Body temperature - 36.5
• BP - 130/95 mmHg
• Pulse - 96 bpm. per minute
Complete blood count: № 2
• Hemoglobin - 133 g / l;
• Red blood cells - 4-5x10 * 12 / L;
General urine analysis: № 2
• Quantity - 150 ml;
• Color - light yellow;
• Relative density of urine - 1015
• Transparency - transparent;
• Response - sour;
• Protein - abs;
• The bile pigments - negative
• Epithelium - 1-2-3 in sight
• White blood cells - 2-3-4 in sight
number 2
Ro ": On the plain film of the hip in frontal projection celebrated the fracture of the hip
bone on the right. (students receive hands on the corresponding Ro ", without interpretation
and conclusion)
5. PRACTICAL PART
Technique of skeletal traction
1. Purpose: To create the conditions in the medium to the physiological status of the full
consolidation of fractures.
2.Indication: Unstable fractures, patients older than 5 years, as well as fractures in violation
of the anatomical structure of skin
3. Equipment: table manipulation, electric drill, clamp, and needle Kirchner.
4. Performed steps (stages).
Activities
Not
All
№
performed
properly
executed
1
Puts the patient on the table, puts a knee roll…
0
20
.
2
Antiseptic solution processes conducted field
0
20
.
manipulations
3
Needle holds the inside of the thigh laterally 2 cm above
0
20
.
the patella.
4
The edge of the spokes of the ball and wrap in alcohol
0
20
.
needle fixed to the bracket.
5
Reduce a bone fragments and puts the patient in a
0
20
.
functional bed with a suspended load.
6. Types of testing the knowledge
-
Oral;
Writing;
Case studies;
Show ability to perform practical skills.
6.1. Types of students’ knowledge control
№
Points
Score
Level of student’s knowledge
1
96-100
Excellent
Depending on the situation, to make the right decision and
concludes.
In preparation for practical training uses additional literature (both
native and English). Essentially independently analyzes the problem
of disaster medicine.
Themselves can examine the patient and correct diagnoses plan
assigns emergency medical care and prevention of complications.
Shows high activity, creativity during interactive games. Correctly
solve situational problems with full justification of the answer.
During the discussion of the CDS is actively asking questions,
making additions. Practical skill performs confidently, understand
the essence.
«5»
2
91-95
In preparation for practical training uses additional literature (both
native and English). Essentially independently analyzes the problem
of disaster medicine. Themselves can examine the patient and
correct diagnoses plan assigns emergency medical care and
prevention of complications. Shows high activity, creativity during
interactive games. Correctly solve situational problems with full
justification of the answer. During the discussion of the CDS is
actively asking questions, making additions. Practical skill performs
confidently, understand the essence.
3
86-90
Essentially independently analyzes the problem of disaster
medicine. Shows high activity, creativity during interactive games.
Correctly solve situational problems, justifies treatment is
prevention plan. AFI knows musculoskeletal system, says
confidently. There is an exact representation of the etiology,
pathogenesis, clinical picture, can carry differential diagnosis,
prescribe treatment, can take preventive measures.
Practical skill performs confidently, understand the essence.
Properly collect history, examines the patient, makes a preliminary
diagnosis. Can interpret the data Ro "research. Actively involved in
the discussion CDS.
4
Shows high activity during interactive games.
Correctly solve situational problems, but can not assign a specific
treatment, confuses the names of immobilization. AFI knows
musculoskeletal system, says confidently. There is an exact
representation of the etiology, pathogenesis, clinical picture, can
carry differential diagnosis, prescribe treatment, but can not carry
out preventive measures. Practical skills to step through.
Properly collect history, examines the patient, makes a preliminary
diagnosis. Can interpret the data Ro "research. Actively involved in
the discussion.
76-80
6
71-75
Good
«4»
7
66-70
Correctly solve situational problems, knows how to put on the
classification of the clinical diagnosis, but can not assign a plan of
treatment and prevention.
AFI knows musculoskeletal system, says confidently. There is an
exact representation of the etiology, pathogenesis, clinical picture
and differential diagnosis, but can not prescribe medication.
Practical skill to perform, but confusing steps.
Properly collect history, examines the patient, makes a preliminary
diagnosis. Can interpret the data Ro "research. Actively involved in
the discussion CDS.
Correctly solve situational problems, but can not justify the clinical
diagnosis. AFI knows musculoskeletal system, says confidently.
There is an exact representation of the etiology, pathogenesis and
clinical, but can not carry out differential diagnosis and prescribe
treatment. Properly collect history, examines the patient, but can
not assess the severity. May partly interpret data Ro "research.
Actively involved in the discussion CDS.
8
61-65
Satisfactory.
«3»
9
55-60
1
0
54 -30
1
1
20-30
Making mistakes in solving situational problems (can not put a
diagnosis on classification). Knows clinic injury, but said
uncertainly. Has a faithful representation on disaster medicine, but
can not relate to the pathogenesis of the clinic. History was not
focused, not on the inspection scheme. Can not interpret the
research data. Passive when discussing CDS.
Has general knowledge about disaster medicine, but doesn’t know
clearly. Mixes the muscle-skeletal system. Individualy can’t ask and
examine the patient. Can’t interpret the X-ray investigations.
Doesn’t participate in discussion of CDS.
Bad.
«2»
Very Bad.
«2»
Doesn’t have any knowledge about disaster medicine. Doesn’t
know the anatomy of muscle-skeletal system.
For showing up in class, for having educational
equipment(stethoscope and note books) and specific clothing
7. Chronologic map of the lesson
Time
08.30-09.15
09.20-10.05
10.20-11.05
Events
1. Theoretical analysis of
the theme "Fractures of
the lower extremities,
pelvis and spine
children, "the main clinical
signs of bone fractures hip,
leg, foot, pelvis and spine,
the principles of first aid,
survey, the types of
anesthesia, the principles
of Immobilization.
2. Solution and analysis of
situational challenges.
Conducting practical skills,
interpretation of X-ray
images;
Local anesthesia the
fracture site;
Preparation casts;
the imposition of languet
and circular casts
Supervision of patients
with injuries of bones
shoulder, forearm and
hand in the office
Content
1. Test baseline level of
preparedness of
students. Poll students
on lessons using the
game "weak link"
2.Test clinical thinking of
students
Materials
1. Banners corresponding subject
classes, test questions.
2. Situational tasks relevant
topic classes
Check the level of
preparedness of students
to practical skills
X-Ray pictures, tires, syringes,
procaine -1% plaster bandages
Each student is
supervised by the
Chamber of patients with
certain clinics involved in
the application of plaster
cast and skeletal traction
Patients appropriate subject
classes, plaster, bandages, bus
Beller, hook, string and weight
11.10-11.50
Report on supervised
patients.
12.30-13.15
Summing up the final
results and assessment of
students' knowledge
Each student will report
on the work done during
the patient's supervision.
Analysis of students'
knowledge
Rentgent pictures, X-ray view
box. Tables.
Baseline data, the correctness of
the decision and the analysis of
situational tasks, skills and
supervision of patients
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
8.
Test questions
Diagnosis and treatment in fractures of the proximal femur
Diagnosis and treatment in fractures of the upper thigh
Diagnosis and treatment in fractures of the middle third of the thigh
Diagnosis and treatment in the lower third of thigh fracture
Diagnosis and treatment in fractures in the knee joint
Diagnosis and treatment in fractures of the shin bone
Diagnosis and treatment in fractures of the ankle.
Diagnosis and treatment in fractures of the foot
Diagnosis and treatment in fractures of the pelvis
Diagnosis and treatment strategy for spinal cord injury
1.
2.
3.
4.
5.
6.
9.
Recommended Reading
Yumashev GS "Trauma and Orthopedics, Moscow,"Medicine "1990. - 575s.
Musalatov HA "Trauma and Orthopedics, Moscow,"Medicine "1995. -s.
A. Kaplan, "Damage to bones and joints," Moscow, "Medicine> 1979. -568s.
WWW.jbjs org.uk
WWW.traumatic.ru
WWW.trauma.bd.ru
Head of chair Karimov M.Yu.