Presumptive diagnosis: closed fracture of the 10th rib on the left

2. Suspected complication: rupture of the spleen and internal bleeding

3. Diagnostic methods: X-ray of the chest cavity, X-ray: head, spine, limbs and chest. Abdominal ultrasound. Laparocentesis.

4. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status. Therapist’s consultation. X-ray of the chest organs and x-ray of the chest in two projections to clarify the site of the fracture.

5. Fixation of the cervical spine with a Shants collar, installation of a cubital catheter, infusion therapy, transportation of the patient to the hospital.

TASK #8

Specialty traumatology and orthopedics

Institute of Surgery

After exercise, a patient developed a deformity of the right shoulder girdle with protrusion of the acromial end of the clavicle upwards. It has been 6 months since the injury, but there are still pains at work, the strength in the hand remains reduced.

Name:

1. What is the preliminary diagnosis

2. The volume of examination of the patient upon admission to the hospital

3. A characteristic symptom in this pathology

4. Methods of treatment of this pathology

5. Operative method of treatment

1. Probable diagnosis: Chronic dislocation of the acromial end of the right clavicle

2. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status.

3. When pressing on the collarbone, the dislocation is quite easily eliminated, but once the pressure is stopped, it reappears. This is the so-called “symptom of the key”, which serves as a reliable sign of a rupture of the acromioclavicular joint.

4. There are conservative and surgical methods of treatment. The conservative method includes the reduction of the clavicle and its fixation with various bandages, splints and devices that put pressure on the acromial end of the clavicle.

5. With chronic dislocations, patients should be sent to a hospital for surgical treatment. Various metal structures are used (screws, plates, spokes, wire).

TASK #9

Specialty traumatology and orthopedics

Institute of Surgery

The patient has a severe traumatic brain injury requiring strict bed rest. In addition, a fracture of the clavicle in the middle third with a typical displacement of fragments was revealed, as well as fractures of several ribs.

Questions:

1. Preliminary diagnosis

2. What complications are possible in this patient

3. The volume of medical care at the prehospital level.

4. Methods of examination

5. Treatment methods for these pathologies

1. Probable diagnosis: Closed craniocerebral injury, concussion. Closed fracture of the middle third of the clavicle with displacement of fragments. Rib fracture.

2. Possible: the occurrence of cerebral hematoma, compression of the subclavian artery, closed pneumo-, hemothorax.

3. Drug analgesia, application of the Shants collar, bleeding control, if any, transport immobilization, installation of a cubital catheter, transportation to a hospital.

4. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status. X-ray of the organs of the chest cavity, X-ray: skull, spine, limbs and chest. Abdominal ultrasound. MRI of the brain. Radiography of the left clavicle area: usually in one direct anteroposterior projection.

5. Strict bed rest. Conservative treatment consists in a one-stage reposition of fragments with their subsequent fixation in the correct position for the period necessary for fusion. In this case, there is a fracture of the clavicle with displacement of fragments, which can be complicated by compression of the subclavian artery, this is an absolute indication for open reposition. Mucolytics, breathing exercises.

TASK #10

Specialty traumatology and orthopedics

Institute of Surgery

Patient I., 22 years old, after an unsuccessful jump from a height of 2.5 m, was diagnosed with “stretching of the Achilles tendon with its partial rupture.” Plaster immobilization for a period of 1 month. and subsequent conservative treatment for 6 weeks did not lead to success.

Currently, there is no active plantar flexion of the foot. With passive dorsiflexion, tension of the Achilles tendon does not occur, and even, on the contrary, retraction of soft tissues appears in this area. The patient cannot stand on the fingers of the injured limb.

Question:

1. Indicate the diagnosis of damage

2. Indications for surgery

3. Possible treatments for this injury

4. Plastic method according to A.F. Krasnov

5. Immobilization of the limb after surgery

1. “Long-term rupture of the Achilles tendon.”

2. Due to muscle retraction, sew the tendon end to end after 2.5 months. after an injury it is not possible, it is necessary to resort to plastic surgery.

3. With a belated diagnosis of Achilles tendon ruptures, various plastic surgeries are used

4. Method A.F. Krasnov. A distinctive feature of the method is the abandonment of the parathenon and the immersion of the tendon autograft into it. This preserves the vessels and nerves surrounding the tendon, as well as the sliding apparatus, ensures good regeneration and restores the anatomical and physiological principles of this zone.

5. After the operation, the limb is immobilized for 3 weeks with a circular plaster bandage from the upper third of the thigh to the fingertips in the position of flexion of the lower leg and foot to an angle of 150°. Then, for another 3 weeks, a plaster “boot” is applied, but the flexion in the knee joint is reduced to 175°, in the ankle joint – 90°.

TASK #11

Specialty traumatology and orthopedics

Institute of Surgery

A patient (26 years old) was hit on the head with a stick. He briefly lost consciousness. 2 hours after the injury, he was taken to the FAP, accompanied by his wife. Examined by a paramedic. Makes no complaints. The smell of alcohol from the mouth. There was a bruise 8 x 12 cm in the left temporo-parietal region. There were no local, meningeal or stem signs. The patient refuses examination, speaks foul language. Tries to go home. Not amenable to persuasion. He was released home with a diagnosis of soft tissue injury of the head, alcohol intoxication. Houses rampaged about 40 minutes. Tried to go somewhere, then went to bed without undressing. The patient could not be awakened in the morning. Suspecting something was wrong, the wife called an ambulance. Delivered to the district hospital.

The patient is unconscious, does not respond to pain stimuli. The left pupil is dilated and does not react to light. Neck stiffness. Right-sided hemiplegia. Noisy breathing, Kussmaul type, 26 breaths per minute. Blood pressure 150/100 mm Hg. The pulse is tense, 60 beats per minute. Craniograms revealed a fracture of the left temporal bone.

Questions:

1. Presumptive diagnosis.

2. What complications arose in this patient.

3. What confirms the diagnosis.

4. What mistakes were made during the initial examination.

5. Tactics of treating the patient.

1. Presumptive diagnosis: fracture of the temporal bone.

2. Intracranial hematoma, traumatic coma.

3. The diagnosis is confirmed by a trauma with a history of loss of consciousness, the presence of a “light gap”, the subsequent deterioration of the condition up to loss of consciousness, the appearance of local, meningeal and stem symptoms, a craniogram.

4. The grossest mistake during the initial examination is that with obvious signs of a craniocerebral injury (loss of consciousness, extensive bruising on the head), the victim was not hospitalized. The reason for the errors was negligence, the lack of alertness of the paramedic to the occurrence of intracranial hematomas. The danger of “light injury” is not taken into account, especially in alcohol intoxication, which smooths out the picture of craniocerebral damage.

5. You can clarify the diagnosis using CT, EEG, EchoCT, angiography. Outpatient treatment of such patients is a gross medical error! This patient had to be urgently hospitalized, immediately clarify the diagnosis with the help of additional methods of treatment. This patient is indicated for urgent surgery.

TASK #12

Specialty traumatology and orthopedics

Institute of Surgery

A young man (23 years old) was injured in a car accident. Complains of pain in the right hip joint. Forced to lie on his back. There is marked lordosis in the lumbar region. The right leg is sharply bent, adducted and rotated medially. The anatomical length of the limb is the same. The greater trochanter is slightly higher. On palpation, there is a retraction under the pupart ligament on the right and a protrusion under the region of the acetabulum at the back. Movement in the right hip joint is sharply limited, painful. A positive symptom of “spring resistance” is noted.

Question:

1. Make a preliminary diagnosis

2. Methods of examination of the patient

3. Differential diagnosis

4. Method of treatment of this patient

5. Is it necessary to perform immobilization for this ballroom?

1. Probable diagnosis: posterior sciatic dislocation of the right hip.

2. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status. Therapist’s consultation. It is necessary to perform an x-ray examination. Be sure to check the pulsation in the peripheral arteries of the lower limb.

3. It is necessary to differentiate with a fracture of the femur and pelvis.

4. Treatment: closed hip reduction under general anesthesia. The limb is fixed with a trough-shaped splint from the angle of the scapula to the end of the fingers for 4 weeks (gypsum immobilization can be replaced by traction with a load of 1-2 kg for the same period). Walking on crutches for 8-10 weeks. The load on the leg is allowed no earlier than 3 months from the moment of injury.

5. Lack of immobilization or traction after reduction of traumatic hip dislocation, early loading of the limb can lead to aseptic necrosis of the femoral head.

TASK #13

Specialty traumatology and orthopedics

Institute of Surgery

A patient (24 years old) jumped from a height of 2.5 meters. He felt a sharp pain in the calcaneus. The back of the foot is swollen. Palpation, as well as axial load along the vertical and frontal axes of the foot, reveals pain in the projection of the calcaneus, most pronounced in the area of the calcaneal tubercle. Can’t step on the foot.

Questions:

1. Make a preliminary diagnosis.

2. Examination of the patient

3. Conservative method of treatment

4. Operative method of treatment

5. Term of recovery

1. According to the available clinical picture, the patient has a fracture of the right calcaneus.

2. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status. For specification of the diagnosis the roentgenogram in two projections is necessary.

3. Conservative method of treatment: blockade of the fracture site, reposition of fragments are performed. After the manipulation, a circular plaster bandage is applied from the end of the fingers to the knee joint. Immobilization terms: permanent for 12 weeks, removable splint – for another 3-4 weeks.

4. Surgical treatment is used when a broken bone consists of large fragments that have lost congruence with neighboring bones, and conservative methods of treatment are not effective. The compared fragments are connected: with screws and metal structures.

5. Ability to work is restored after 20 – 24 weeks.

TASK #14

Specialty traumatology and orthopedics

Institute of Surgery

A patient (39 years old) had a 10 kg item fall on his foot. Examination reveals swelling and a positive axial load in the zone I-III of the metatarsal bones, pain on palpation, there is no bone deformity, the load on the foot is sharply painful.

Questions:

1. Make a preliminary diagnosis

2. Examination of the patient

3. Additional examination methods

4. Determine the tactics of treatment

5. Recovery time

1. The patient, judging by the clinical data, has a fracture of the I-III metatarsal bones without displacement of the fragments.

2. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status. Therapist’s consultation.

3. To clarify the diagnosis, radiography in two projections is necessary.

4. If the diagnosis is confirmed, the patient should apply a circular plaster bandage from the end of the fingers to the upper third of the lower leg with a well-modeled arch. From the third day, it is necessary to assign UHF to the area of damage, static gymnastics and allow walking on crutches, slightly stepping on the leg.

5. Ability to work is restored after 6 – 8 weeks. Patients who have suffered fractures of the bones of the foot should, within 6-12 months. wear an arch support.

TASK #15

Specialty traumatology and orthopedics

Institute of Surgery

Girl 2 years old went late. From the anamnesis: she was born in breech presentation. Objectively: the left lower limb is shortened by 1 cm, abduction in the left hip joint is limited. Walking with a roll to the left side. Trendelenburg’s sign is positive. By the evening there are pains in the field of the left coxofemoral joint.

Questions:

1. Make a preliminary diagnosis

2. Examination of the patient

3. Additional examination methods

4. Determine the tactics of treatment

5. Determine the indications for surgical treatment

1. A girl has a left-sided congenital dislocation of the hip joint.

2. Examination of the patient, interviewing parents, getting acquainted with the history of the disease, measuring the absolute and relative length of the lower limb. Diagnosis of the disease is determined by late clinical symptoms.

3. X-ray diagnosis is represented by the Hilgenreiner scheme (which allows you to determine the early underdevelopment of the hip joint and the location of the femoral head relative to the articular cavity before the appearance of ossification of its nucleus).

4. Conservative treatment of congenital dislocation: fixation in the Vilensky splint with a gradual load on the lower limbs. Gypsum immobilization according to Ter-Egiazarov-Sheptun. Vertical stretch.

5. Surgical treatment: Open reduction operation with arthroplasty followed by plaster immobilization in the postoperative period.

TASK #16

Specialty traumatology and orthopedics

Institute of Surgery

The patient (24 years old) fell to his feet from the balcony of the 4th floor. He felt a sharp pain in his back, because of which he could not stand up on his own. On examination, there is a smoothness of lordosis in the lumbar region, visible muscle tension in the form of “reins”, converging to the 1st lumbar vertebra. Movement in the lumbar spine is sharply limited due to severe pain. Axial load symptom is positive. Palpation of the spinous processes is painful in the area from the XII thoracic to the III lumbar, especially when feeling the spinous processes with a simultaneous attempt by the patient to raise the extended legs. There are no signs of spinal cord injury.

Questions:

1. What is the preliminary diagnosis?

2. Examination of the patient

3. Draw up an algorithm for therapeutic measures at the prehospital stage

4. Additional examination methods

5. Draw up an algorithm for therapeutic measures in the hospital

1. Clinically, a fracture of the 1st lumbar vertebra is determined in a patient.

2. Examination of the patient, questioning, familiarization with the circumstances of the injury, concomitant diseases, studying the local status.

3. Introduce analgesics, the patient should be laid on a shield, a Shants collar should be applied, transport immobilization, transported to a hospital.

4. In the hospital, the patient is again examined, questioned, familiarized with the circumstances of the injury, concomitant diseases, and the study of the local status. Therapist’s consultation. An X-ray examination and a decision on the stability of the fracture are necessary.

5. In the department of the patient, I put it on the shield, put a reclinator roller under the fracture site. Prescribe painkillers. Strict bed rest. After the pronounced pain syndrome subsides, they begin to perform a complex of therapeutic exercises.

TASK #17

Specialty traumatology and orthopedics

Institute of Surgery

A 12-year-old boy first applied to an orthopedist at the place of residence with complaints of the inability to turn his head to the right. Objectively: asymmetry of the facial skull: the superciliary arch is lower on the right side, the palpebral fissure is already on the right, the corner of the mouth is lowered on the right, the right clavicle is asymmetric.

Questions:

1. Make a preliminary diagnosis

2. Examination of the patient

3. Additional examination methods

4. Determine the tactics of treatment

5. Determine the indications for surgical treatment

1. The child has congenital right-sided muscular torticollis, which is confirmed by clinical symptoms.

2. Examination of the patient, interviewing the patient and parents, familiarization with the history of the disease. Diagnosis of the disease is determined by late clinical symptoms (asymmetry of the facial skeleton).

3. Ultrasound (sonography) of the sternocleidomastoid muscle (GCSM).

4. Since torticollis was first diagnosed in a child at the age of 12, surgical treatment should be resorted to. Operation Zatsepin: open intersection of the heads of the modified muscle in its lower part.

5. Federl operation: Myoplastic lengthening of GCSM. It is most effective when the muscle is shortened by no more than 40% in relation to a healthy one. In the postoperative period for 1 month. Thoraco-cranial plaster cast in hypercorrection position (head turned to the healthy side and forward, cervical spine tilted back).

TASK #18

Specialty traumatology and orthopedics

Institute of Surgery

An elderly plump woman walked along the icy sidewalk. She slipped and fell, leaning on the palm of her outstretched right hand. There were severe pains in the wrist joint. Went to the emergency room. Objectively: the right wrist joint is edematous, movements in it are very painful and limited. A “bayonet-shaped” deformity of the joint is clearly defined (the distal fragment, together with the hand, is displaced to the rear). Palpation of the dorsum of the joint is painful. Axial load causes increased pain at the site of injury.

Questions:

1. What is your diagnosis?

2. What additional research should be done?

3. How will anesthesia be administered?

4. What method of treatment should be chosen?

5. How will the immobilization of the damaged area be carried out?

1. Diagnosis: closed fracture of the right radius in a typical location.

2. Radiography of the right wrist joint in direct and lateral projections.

3. Simultaneous closed manual reposition will be carried out under local anesthesia 1% solution of novocaine-20 ml.

4. Treatment is conservative. Technique for manual reposition of a Collis fracture (extension fracture). The patient sits sideways to the table and puts an arm bent at the elbow on it so that the distal fragment and the hand hang over the edge of the table.

One assistant with one hand captures the 1st finger of the patient and the region of the 1st metacarpal bone, the other – II-IV fingers. The second assistant, performing counter-traction, fixes the shoulder. With manual reduction, assistants stretch the fragments slowly, over 3-5 minutes, eliminating the shortening of the limb. After reposition, the fragments are fixed with fingers and the hands are placed in a position of moderate dorsiflexion, a back gypsum splint is applied from the metacarpophalangeal joints to the elbow joint. Comparison of fragments is checked by a control radiograph.

5. A fracture of the radius in a typical location is treated by applying a palmar or dorsal plaster splint to the hand and forearm. The forearm and hand are placed in a position intermediate between pronation and supination. The hand is in the position of a slight dorsiflexion of the “girth of the tennis ball”.

TASK #19

Specialty traumatology and orthopedics

Institute of Surgery

The diver hit his head on the ground in shallow water. Worried about pain in the cervical spine. Objectively: the head is in a forced position. Palpation of the spinous processes of the V and VI cervical vertebrae is painful. There is a deformation in the form of a noticeable protrusion of the spinous processes of these vertebrae. The patient’s attempts to move his head are almost impossible, very painful and significantly limited. Sensitivity and motor function of the upper and lower extremities are preserved in full.

Questions:

1. What is your diagnosis?

2. What additional research should be done?

3. What possible complications should I look out for?

4. How to carry out transport immobilization?

5. What treatment should be prescribed?

1. Closed uncomplicated compression fracture of the CV-CVI bodies of the cervical vertebrae.

2. Inspection, questioning, palpation, detection of the symptom of “positive axial load along the axis” when pressing on the victim’s head and spinous processes. Spondylography of the cervical spine in two projections. CT scan of the cervical spine.

3. Possible complications: paresthesia, paraplegia or paralysis of the upper limbs as a result of spinal canal stenosis.

4. Transport immobilization on a shield on the back with a Shants collar or head holder of the collar zone of the spine.

5. Paravertebral novocaine blockade. The imposition of SV behind the parietal tubercles with a complicated fracture of the spine, with an uncomplicated imposition of the soft tissue loop of Glisson behind the cervical spine.

TASK #20

Specialty traumatology and orthopedics

Institute of Surgery

The patient was crushed by collapsed boxes. Complains of a sharp pain in the right half of the chest, the impossibility of a full breath. Severe condition. Cyanosis of the skin. Dyspnea. AD 170/100 mm. rt. Art. The right half of the chest falls sharply behind when breathing. Percussion reveals a box sound over the entire right half of the chest, breathing on the right is not auscultated. The heart is displaced to the left. Palpation determined multiple fractures of the right ribs.

Questions:

1. Damage diagnosis

2. Specify the most probable complication of this injury

3. Plan for examining a patient in a hospital

4. Emergency treatment plan

5. Terms of recovery

1. Presumptive diagnosis: multiple fracture of the ribs

2. Closed pneumothorax

3. Examination of the patient, questioning, clarification of the circumstances of the injury, concomitant diseases, study of the local status. Therapist’s consultation. X-ray of the chest organs and x-ray of the chest in two projections to clarify the site of the fracture.

4. Blockade of the fracture site. Puncture of the pleural cavity in the 2nd intercostal space, where air will be obtained. Medical analgesia. X-ray control of the chest. Auscultation of the lungs. Expectorant mixtures, breathing exercises. Re-blockade of fracture sites as needed. Breathing exercises.

5. Fracture union occurs in 3-4 weeks. Ability to work is restored after 4-5 weeks.

TASK #21

Specialty traumatology and orthopedics

Institute of Surgery

Three days ago, the patient hit his back when falling from the sharp braking of the bus. The polyclinic doctor established the presence of a fracture of one rib on the left, applied a pressure bandage to the chest, and recommended taking analgesics. The patient’s condition did not improve, there was pain during breathing. This was accompanied by a cough with sputum. Shortness of breath began to increase. The patient has tachycardia, cyanosis of the lips, high temperature, a sharp weakening of breathing on the left, scattered moist rales.

Questions:

1. Set a presumptive diagnosis:

2. Methods of examination.

3.Possible complications in this injury

4. Note the doctor’s mistakes that contributed to the deterioration of the condition, the occurrence of complications;

5. Make an algorithm for diagnostic and therapeutic measures in patients with rib fractures.

1. Presumptive diagnosis: Closed fracture of the rib on the left

2. Examination of the patient, questioning, clarification of the circumstances of the injury, concomitant diseases, study of the local status. Panoramic radiography of the chest, radiography of the chest in two projections.

3. Pneumonia.

4. When the ribs are broken, do not apply a pressure bandage.

5. Medication analgesia, antibiotics, mucolytics, physiotherapy, breathing exercises.

TASK #22

Specialty traumatology and orthopedics

Institute of Surgery

A high school student of the 6th grade rode on the stair railing. At the next attempt to move down, he fell on the left arm extended at the elbow joint, resting on the palm. The forearm at the same time, as it were, “overbent”. As a result of this injury, there was severe pain in the elbow joint. I went to the emergency room for help. Objectively: the left elbow joint is enlarged, deformed, the cubital fossa is smoothed. With careful palpation, the olecranon protrudes from behind. The axis of the shoulder is shifted forward. The hand is in a forced semi-extended position. The victim holds it with his healthy hand. Active movements in the elbow joint are impossible. When attempting passive movements, springy resistance is felt.

Questions:

1. Make a preliminary diagnosis?

2. What additional research needs to be done?

3. Which of the listed symptoms are absolute for this damage?

4. How will the damage be treated?

5. How will the immobilization of the elbow joint be carried out?

1. Diagnosis: Posterior dislocation of both bones of the left forearm.

2. Inspection, questioning, palpation, radiography of the left forearm with the capture of the elbow joint in two projections.

3. The mechanism of the injury as a result of overextension of the forearm. The cubital fossa is smoothed, the olecranon is palpated in an atypical place, the axis of the shoulder is displaced anteriorly. Active movements in the elbow joint are impossible. When attempting passive movements, springy resistance is felt.

4.Reduction of posterior dislocations of the forearm. The patient is placed on the dressing table, the injured arm is raised, and the assistant holds it by the hand, being on the opposite side of the table. The surgeon covers the anterior surface of the shoulder above the elbow joint with two brushes, and with his thumbs presses on the olecranon, moving the shoulder backwards, and the forearm forwards, which, with simultaneous gradual flexion of the forearm by an assistant holding the brush, leads to the reduction of the dislocation.

5. After the reduction of the dislocation, the elbow joint must be fixed with a plaster splint at a right angle; the forearm is placed in a supination position. Such a bandage is applied for 5-10 days, depending on the degree of damage to the ligamentous apparatus and the tendency to re-dislocation.

TASK #23

Specialty traumatology and orthopedics

Institute of Surgery

A 46-year-old patient was crushed between logs while unloading a railway platform. After removing the pressure, he could not move independently. Complains of pain in the left inguinal region, aggravated by movement of the corresponding limb. The pelvis is externally of a normal configuration. The distance from the upper anterior iliac axes to the navel is the same on the right and left. On palpation, moderate swelling and severe pain in the left inguinal region. The axial load on the pelvis in the frontal plane is weakly positive on the left, in the sagittal plane it is doubtful due to pain in the area of the pubic symphysis. The length of the limbs is the same. Positive symptom of stuck heel on the left.

Questions:

1. Make a preliminary diagnosis

2.Methods of examination of the patient

3. What other injuries should be ruled out with such an injury mechanism

4.Methods of treatment at the hospital stage

5.Indications for surgical treatment

1. Preliminary diagnosis: the patient has a fracture of the upper branch of the pubic bone on the left.

2. Examination of the patient, questioning, clarification of the circumstances of the injury, concomitant diseases, study of the local status. Clinical analysis of blood and urine. To clarify the diagnosis, an x-ray of the pelvic bones is necessary, which will give accurate information about the nature of the fracture.

3. Damage to the anterior half-ring of the pelvis may be accompanied by rupture of the bladder and urethra, so the study of the excretory function of these organs is mandatory. In addition, a thorough clinical examination of the patient is required in order to exclude traumatization of the abdominal organs, especially since tense abdominal muscles (attached to the pubic bones!) Complicate the clinical picture. The symptom of “stuck heel” can also be with fractures of the lumbar vertebrae and their transverse processes.

4.Conservative methods. They are used to treat patients with all types of pelvic fractures, ruptures of the pubic and sacroiliac joints without significant displacement. Operative method using different plates and screws.

5. Inability to compare fragments of the pelvic bones in a conservative way, with chronic ruptures of the pubic symphysis and sacroiliac joint, with ruptures of the bladder, urethra and rectum.

TASK #24

Specialty traumatology and orthopedics

Institute of Surgery

The young man, defending himself from a blow with a stick, raised his left arm above his head, bent at the elbow joint. The blow fell on the upper third of the forearm. There was severe pain at the site of the injury. The forearm is bent at the elbow joint, deformed in the upper third, there is a retraction from the side of the ulna and a protrusion along the anterior surface of the forearm. The victim went to the trauma department of the hospital. During an external examination of the left elbow joint, the head of the radius is palpated. Palpation of the deformed area is sharply painful. The injured forearm is somewhat shortened. Active and passive movements of the forearm are sharply limited and painful. The sensitivity of the hand and forearm is not broken.

Questions:

1. preliminary diagnosis?

2. What additional research needs to be done?

3. What is the type of this damage depending on the direction of displacement of the fragments?

4. What is the treatment strategy?

5. How should the forearm be immobilized?

1. Preliminary diagnosis: fracture of the upper third of the ulna with dislocation of the head of the radius of the left forearm (Montagia fracture-dislocation)

2. Inspection, questioning, palpation, radiography of both bones of the left forearm in two projections.

3 Based on the displacement of the fragments, flexion and extensor fractures of Montage can be distinguished. A characteristic feature is the shortening of the injured forearm, as well as its retraction from the side of the ulna and protrusion from the side of the radius, there is a springy resistance when trying to passively flex.

4. Technique of simultaneous closed manual reposition. The patient is placed on the table. One assistant performs counter-traction by the shoulder, the other – stretching the limb by the hand. At the same time, the surgeon presses with his first finger or hand on the head of the radius dislocated in the back side in the direction from back to front and from top to bottom (along the axis of the radius). With the other hand, the surgeon presses the region of the cubital fossa, providing resistance. The reduction is accompanied by a slight click of the radial head that has fallen into place. With continuous holding traction, pressure is applied to the distal fragment of the ulna from back to front.

5. After the reduction of fragments on the limb, unbent at the elbow joint, in the position of supination, a dorsal gypsum splint is applied from the heads of the metacarpal bones to the armpit.

TASK #25

Specialty traumatology and orthopedics

Institute of Surgery

When jumping from a height, the patient twisted his leg inwards. There was a sharp pain in the knee, it became impossible to step on the foot. The knee joint is thickened, the diameter of the lower leg at the level of its condyles is increased. On palpation on the inner surface of the joint – a sharp pain and bone crepitus.

Question:

1. Name the presumptive diagnosis of damage

2.Possible complications in this injury

3. Diagnostic methods

4. Make a plan for conservative treatment

5. Make a plan for surgical treatment

1. Fracture of the medial condyle of the tibia

2. Damage to the ligaments of the knee joint

3. Examination of the patient, questioning, clarification of the circumstances of the injury, concomitant diseases, study of the local status. Clinical analysis of blood and urine. Radiography of the upper third of the leg. Ultrasound of the knee.

4. Blockade of the fracture site, manual reduction, plaster immobilization.

5. Open reposition and fixation of fragments with lag screws and plates using bone autoplasty.

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