Methodical indicatings to operation of students on practical employment The module 4. Practical employment №18.

Subject: Treatment of fractures in a hospital. Dislocations.

Theoretical questions for outclasses self-maintained studying and discussion to practical employment №18:

1. With what treatment of fractures and dislocations begins.

2. What value of the functional method that its short.

3. Displays to extension to a method of treatment.

4. It is necessary to adhere to what rules at applying plaster bandages.

5. Displays to osteometalosintesis.

6. Displays to unclosed and occluded reposition.

7. Possible complications after treatment of fractures.

8. Methods of diaplasis of dislocations.

9. Diagnostics of nee dislocations and their social and economic value.

The literature:

The basic literature:

3. Butyrsky A. General surgery. – Simferopol. 2004.

4. Schevchenko S.I. and others. Surgery. – Kharcov. 2004

The additional literature:

4. Kushnir R. Lectures of General surgery. – 2005.

5. Lyapis M.A. Methods of examination of a surgical patients. – 2004.

6. Methodological recommendations on surgical patients care. – Vinnitsa medical national university. 2006.

Allocation of points that are appropriated to students:

At a digestion of a subject №18 from substantial to the module №4 for educational activity to the student the estimate for 4 balls (traditional) scale which then is converted in points as follows is exposed:

Estimation	Points
"5" excellent	6 Point
"4" good	4 Point
"3" satisfactory	2 Point
"2" unsatisfactory	0 Point

Tests 18 tema

1. For performance insistently occluded reposition and osteal spalls first of all necessary

1 redresation

2 rotation with bracing

3 Abduction of an extremity

4 Reduction of an extremity

5 Blockage of a place of fracture

2. The first moment uninstantly occluded reposition and osteal spalls is termed:

1 reposition

2 Bracing

3 extensition

4 мcontrary extension

5 Abduction

3. The latin name of the first moment uninstantly reposition and osteal spalls:

1 сdislocatio

2 ехtensio

3 reclinatio

4 combustio

5 luxatio

4. Bracing at uniinstantly occluded reposition osteal spalls is carried out behind the help:

1 Operations

2 Sceletal extention

3 Plaster bandage

4 The transport splint

5 Kramer's splints

5. Bracing at many-stage occluded reposition and osteal spalls is carried out behind the help:

1 Operations

2 Sceletal extention

3 Plaster bandage

4 The transport splint

5 Kramer's splints

6. At sceletal extention contrary extension it is reached by means of:

1 Weights

2 Standing of the patient in bed with the lifted tender extremity

3 Abduction

4 Reduction

5 Plaster bandage

7. At sceletal extention traction is reached behind the help:

1 Weights

2 Standing of the patient with the lifted tender extremity

3 Abduction

4 Reduction

5 Plaster bandage

8. Shift of osteal spalls on breadth in latin tongue:

1 dislocacio ad ахin

2 dislocacio ad latum

3 dislocacio ad реreferiarum

4 dislocacio ad longitudinale

9. Reposition osteal spalls at sceletal extention it is erected behind the help:

1 Measuring of the relative length of an extremity

2 Palpation

3 The survey

4 Measuring of terrain clearance length of an extremity

5 Measuring of a weight of the weight

10. The basic assignment of the first stage of treatment at occluded reposition and osteal spalls:

1 Recommencing of function of an extremity

2 Recommencing of anatomical integrity of a bone

3 To development of joints

4 Making of a physiologic standing of an extremity

5 Making of the forced standing of an extremity

11. The basic assignment ІІ a stage at occluded insistently reposition and after recommencing anatomical integrity of osteal structure is erected to:

1 Recommencings of function and development of joints

2 reposition osteal spalls

3 Formation of a pseudo-joint

4 osteometalosynthesis

5 Sceletal extension

12. For the correct comparison of osteal spalls at fractures of bones of extremities at sceletal extension:

1 The central spall concerns on peripheric

2 The peripheric spall concerns on central

3 The extremity is tapped

4 Rotation change stack

13. At the open fracture use a following plaster bandage:

1 Circular

2 londetti

3 window

4 Gypseous corset

5 Gypseous splint

14. The metal hinge at intramedulary osteometalosyntes on diameter should:

1 To be smaller on 1 mm

2 To be thicker on 1 mm

3 To be thicker on 5 mm

4 To be smaller on 5 mm

5 Precisely to respond diameter of the done marrow canal

15. Application compression-distraction allows reaching a method of treatment of fractures:

1 Secondary accreting

2 Primary accreting

3 Artificial to a joint

4 Interposition and tissues

5 Pathological mobile

16. One of the parents of formation vicious to a joint is:

1 Kind blood supply of osteal spalls

2 Kind immobilization

3 Insufficient{Poor immobilization

4 Ankilos by upper situated to a joint

5 Arrest of development of muscles

17. One of the parents of formation vicious to a joint is:

1 Kind blood supply of osteal spalls

2 Kind immobilization

3 interposition tissues between spalls

4 Ankilos by upper situated to a joint

5 Arrest of development of muscles

Situational problems

1. In traumatology unit the patient after road accident with complaints to a pain in a right femur, sharp disturbance of function has entered. At the survey of a femur the appreciable thickening of the soft tissues in the upper third, a positive sign "riding breeches" is scored, the extremity is truncated on 5 see At a stage of first aid lead immobilization by splint Diterihsa. Joint-stock company 80/55 mm.pt.st sphygmus 106 in min.

A. Put the previous diagnosis.

B. Plan of the previous treatment of the victim.

Century the how is necessary for leading survey.

2. The man at slope from height on moderately incurvated legs has felt a birch a pain below patellar to a joint. Complains, that anticnemions "do not obey" at performance of a step forward. At a palpation still schin bones - the appreciable pain, patella it is displaced up.

A. Put the previous diagnosis.

B. Call a radiological attribute of damage.

Century who need to be used a method of treatment?

Of the how promptness medical measure?

3. The patient complains of a gonalgia which has occurbed at slope on in front on a surface of a joint. At the survey it is defined deconfiguration patellar to a joint, at a palpation - the kneecap is on an exterior surface of a joint, the active motions in a joint miss, passive - are restricted.

A. Put the previous diagnosis.

B. Choose a method of treatment.

4. In clinic the owner of a motor van with the complaint to a pain in a basis of the first dactyl of a right brush was converted. Hour back clockwork tincars stick has struck it on a palmar surface of a brush. At the survey the basic phalanx of the first dactyl is in a back flexion under an angle 80⁰, the head of a metacarpal bone acts on a palmar surface, the distal phalanx is incurvated at right angle.

A.Put the previous diagnosis.

B.Show sequence of activities at diaplasis of a dislocation.

5. Term contra indication for applying a plaster bandage:

1 Presence at the patient onihomicozis

2 Opportunity of development of a mephitic gangrene at the open fracture

3 impacted fracture

4 Damage skins (disease) in a place of applying of a bandage

5 Presence interposition

6 Damage of the main receptacles

6. At the patient on a X-ray pattern inappreciable shift of the left-hand ulna. Whether it is necessary to spend reposition?

7. The patient, as a result of slope on the left-hand brachium, had a dislocation arm-pits heads of a humeral bone. Using what method, it is possible to set a dislocation?

8. At the patient fracture of the inferior third of right femur. What method of treatment of fractures is more expedient?

1 Sceletal extensio

2 osteoclasia

3 Coking bandage

4 Splint CITO

9.

At slope from the car at the patient it is diagnosed diafisis fracture of a femur. Choose an adequate method of treatment of the patient.

1 The functional method

2 Use of plug Algunova

3 Intramedular osteometalositesis nail Dubrova

4 Use of plate Krupko

10. Whether it is necessary for the patient after intramedular osteometalositesis nail Klantshnera to impose koksitum a plaster bandage?

11. The patient has entered with a dislocation in the left-hand ulnar joint that has arisen a month ago. Yaks you recommend a method of diaplasis?

1 Method the Mott-Muhina

2 Method Hippocrat

3 Operative treatment

4 Method Koher

12. The patient has entered with complaints to frequent, repeated dislocations of the left-hand brachium. To him have erected the diagnosis: Luxatio humeri habitualis. Appoint treatment.

1 toracobronwalis

2 A bandage

3 Operation with introduce an articulate ascus

4 Weeper{Deflecting} splint CITO

5 osteoclasia

13. The patient has occurbed in a surgical cabinet for putting off of a circular plaster bandage of the left-hand anticnemion. Select necessary instruments.

1 Scissors Listera

2 Forceps Listona

3 Scissors Shtille

4 Yudin's expander

5 Volf's forcepses

Answers:

1. 5 8 2 15 2

2. 3 9 4 16 3

3. 2 10 2 17 3

4. 3 11 1

5. 2 12 ?

6. 2 13 3

7. 1 14 2

1 The answer:

A. Closes diafisis fracture of the upper third of right femur with shift of fragments. postravmatical a shock ІІ item

B. Anesthesia („ infiltrations anestehesia ”) due to injection in a place of fracture 200 ml 0,5 % of У-thow Novocainum from four crossly perpendicular points. Injection hemodinamical blood substitutes (poliglukin 500 ml, reopoliglukin 250 ml, solution Ringera, izosteril on 250 ml, in/m ketalon 22 ml). After deducing from a depressed case to execute sceletal extesion at process a femur or still schin bones

Century roentgenograms the image of a femur

2 The answer:

A. Alienation still shin bones.

B. displacement of a whirl bone burn down.

Century exstramedule osteometalosintesis.

In the first 1-3 days.

3 The answer:

A.Fractura of a kneecap.

B.Ficsation a method (a gypseous dummy bandage after liquidation of a hemarthrosis).

4 The answer:

A.Dislocation in phalanx-wrist a joint of a dactyl of a right} brush.

B. Anesthesia due to carrying out of an anesthesia. Diaplasis of a dislocation.

5 2,4

6 The answer: If shift will not break function the patient does not need to be injured follow-up.

7 The answer: the Method of value} has no, efficiency of diaplasis depends on adequate anesthesia and a release phenomenon.

8 1

9 3

10 The answer: So, differently there can be a rotation distal to a fragment around of a nail.

11 3

12 3

13 3,5