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Pathology of trauma, bone fractures and healing. Also included are pathology of bone including common bone tumors.

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Pathology of Trauma


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    pathology of trauma

    Pathology of Trauma

    <ul><li>if we ignore the &quot;carrot&quot; of our Dreams, then we invite the &quot;stick&quot; of struggle. </li></ul><ul><li>Gill Edwards From &quot;Stepping Into the Magic - A New Approach to Everyday Life&quot; </li></ul>

    cpc4 3 4 19y karen mike ul li karen and mike were

    CPC4.3.4- 19y Karen & Mike, <ul><li>Karen and Mike were returning home from a party in the early hours of Sunday morning. They left the party at about midnight . They were riding Mike’s 500cc motorbike with Mike driving and Karen as passenger. Both had helmets on. </li></ul><ul><li>A passing motorist calls ‘000 ’ at 02h15 asking for an ambulance. He says: ‘…they are both lying on the ground. He is very still . She appears to be in terrible pain and can’t move .’ The location is approximately 20 km from Charters Towers on the Hughenden road. </li></ul><ul><li>The first ambulance arrives about 15 minutes after the 000 call, followed by a police car about 5 minutes later. </li></ul> CPC4.3.4- 19y Karen & Mike, <ul><li>Karen and Mike were returning home from a party in the early hours of Sunday morning. They left the party at about midnight . They were riding Mike’s 500cc motorbike with Mike driving and Karen as passenger. Both had helmets on. </li></ul><ul><li>A passing motorist calls ‘000 ’ at 02h15 asking for an ambulance. He says: ‘…they are both lying on the ground. He is very still . She appears to be in terrible pain and can’t move .’ The location is approximately 20 km from Charters Towers on the Hughenden road. </li></ul><ul><li>The first ambulance arrives about 15 minutes after the 000 call, followed by a police car about 5 minutes later. </li></ul>

    cpc4 3 4 at the scene ul li abc assessment

    CPC4.3.4- At the Scene… <ul><li>ABC assessment </li></ul><ul><ul><li>Mike: airway intact, breathing spontaneously 22 breaths/min, radial Pulse 110 bpm </li></ul></ul><ul><ul><li>Karen-Ann: airway intact, breathing spontaneously respiratory rate 34 breaths/min, radial pulse 140 beats/min </li></ul></ul><ul><li>Detailed examination </li></ul><ul><ul><li>Karen-Ann: bilateral compound femur fractures; ?fractured lower jaw (Left), no chest injury apparent, no abdominal injury apparent </li></ul></ul><ul><ul><li>Mike: L hypochondrial pain, L upper arm pain and loss movement ?fractured L humerus, no chest injury apparent. </li></ul></ul><ul><li>Tutors please introduce/remind students re concept of ‘AMPLE’ history (Allergies, Medications, Past history, Last ate/Tetanus/Events) </li></ul> CPC4.3.4- At the Scene… <ul><li>ABC assessment </li></ul><ul><ul><li>Mike: airway intact, breathing spontaneously 22 breaths/min, radial Pulse 110 bpm </li></ul></ul><ul><ul><li>Karen-Ann: airway intact, breathing spontaneously respiratory rate 34 breaths/min, radial pulse 140 beats/min </li></ul></ul><ul><li>Detailed examination </li></ul><ul><ul><li>Karen-Ann: bilateral compound femur fractures; ?fractured lower jaw (Left), no chest injury apparent, no abdominal injury apparent </li></ul></ul><ul><ul><li>Mike: L hypochondrial pain, L upper arm pain and loss movement ?fractured L humerus, no chest injury apparent. </li></ul></ul><ul><li>Tutors please introduce/remind students re concept of ‘AMPLE’ history (Allergies, Medications, Past history, Last ate/Tetanus/Events) </li></ul>

    cpc4 3 4 at the scene ul li triage decision

    CPC4.3.4- At the Scene… <ul><li>Triage decision who needs to be taken to hospital first? </li></ul><ul><li>Tutors please facilitate this discussion based on ‘ABCD’ findings. The finding of a fractured jaw should immediately raise suspicion of cervical spine fracture; L hypochondrial pain should raise possibility of ruptured spleen </li></ul><ul><li>Which hospital Charters Towers : on call GP; TTH : Trauma unit. What are the pros and cons of each? Tutors: remind students re ‘stay and play’/’scoop and run’ debate; concept of ‘The Golden Hour’. </li></ul><ul><li>The ambulance paramedic calls TTH ED and speaks to the on call consultant; the helicopter is dispatched to collect Karen-Ann to take her to TTH; the ambulance will transport Mike by road to TTH. </li></ul> CPC4.3.4- At the Scene… <ul><li>Triage decision who needs to be taken to hospital first? </li></ul><ul><li>Tutors please facilitate this discussion based on ‘ABCD’ findings. The finding of a fractured jaw should immediately raise suspicion of cervical spine fracture; L hypochondrial pain should raise possibility of ruptured spleen </li></ul><ul><li>Which hospital Charters Towers : on call GP; TTH : Trauma unit. What are the pros and cons of each? Tutors: remind students re ‘stay and play’/’scoop and run’ debate; concept of ‘The Golden Hour’. </li></ul><ul><li>The ambulance paramedic calls TTH ED and speaks to the on call consultant; the helicopter is dispatched to collect Karen-Ann to take her to TTH; the ambulance will transport Mike by road to TTH. </li></ul>

    cpc4 3 4 core learning issues ul li basic science

    CPC4.3.4- Core learning Issues… <ul><li>Basic science - Core Learning Issues: </li></ul><ul><ul><li>Over view of tissue injury & Healing . </li></ul></ul><ul><ul><li>Metabolic response to trauma </li></ul></ul><ul><ul><li>Shock - types and Pathophysiology. </li></ul></ul><ul><ul><li>Hypovolaemic shock </li></ul></ul><ul><ul><li>Limb anatomy : upper, lower, femur, humerus and associations (nerves, vessels, muscle attachments etc) </li></ul></ul><ul><li>Clinical Core Learning Issues: </li></ul><ul><ul><li>Assessment of trauma patients </li></ul></ul><ul><ul><li>Assessing patients in shock. </li></ul></ul><ul><ul><li>Assessment of patients with chest injury </li></ul></ul><ul><ul><li>Glasgow coma score </li></ul></ul> CPC4.3.4- Core learning Issues… <ul><li>Basic science - Core Learning Issues: </li></ul><ul><ul><li>Over view of tissue injury & Healing . </li></ul></ul><ul><ul><li>Metabolic response to trauma </li></ul></ul><ul><ul><li>Shock - types and Pathophysiology. </li></ul></ul><ul><ul><li>Hypovolaemic shock </li></ul></ul><ul><ul><li>Limb anatomy : upper, lower, femur, humerus and associations (nerves, vessels, muscle attachments etc) </li></ul></ul><ul><li>Clinical Core Learning Issues: </li></ul><ul><ul><li>Assessment of trauma patients </li></ul></ul><ul><ul><li>Assessing patients in shock. </li></ul></ul><ul><ul><li>Assessment of patients with chest injury </li></ul></ul><ul><ul><li>Glasgow coma score </li></ul></ul>

    cpc4 3 4 core learning issues ul li pathology

    CPC4.3.4- Core learning Issues… <ul><li>Pathology - Core Learning Issues: </li></ul><ul><ul><li>Pathology of fractures, fracture healing * </li></ul></ul><ul><ul><li>Pathology review of trauma, Tissue injury & Wound healing in skin & special tissues. </li></ul></ul><ul><ul><li>Chest injury – lung collapse, surgical emphysema, </li></ul></ul><ul><ul><li>Abdominal Trauma - Splenic rupture. </li></ul></ul><ul><ul><li>Pathology of Head Injury * </li></ul></ul> CPC4.3.4- Core learning Issues… <ul><li>Pathology - Core Learning Issues: </li></ul><ul><ul><li>Pathology of fractures, fracture healing * </li></ul></ul><ul><ul><li>Pathology review of trauma, Tissue injury & Wound healing in skin & special tissues. </li></ul></ul><ul><ul><li>Chest injury – lung collapse, surgical emphysema, </li></ul></ul><ul><ul><li>Abdominal Trauma - Splenic rupture. </li></ul></ul><ul><ul><li>Pathology of Head Injury * </li></ul></ul>

    quot people blame their circumstances for what

    &quot;People blame their circumstances for what they are. I don't believe in circumstances. The people who get on in the world are the people who get up and look for the circumstances they want, and if they can't find them, make them ….!&quot; - George Bernard Shaw &quot;People blame their circumstances for what they are. I don't believe in circumstances. The people who get on in the world are the people who get up and look for the circumstances they want, and if they can't find them, make them ….!&quot; - George Bernard Shaw

    pathology of bone fracture healing dr venkatesh

    Pathology of Bone Fracture & Healing Dr. Venkatesh M. Shashidhar Senior Lecturer & Head of Pathology Pathology of Bone Fracture & Healing Dr. Venkatesh M. Shashidhar Senior Lecturer & Head of Pathology

    introduction ul li bone is a dynamic tissue

    Introduction: <ul><li>Bone is a dynamic tissue - </li></ul><ul><li>Osteoblasts - osteoid (type 1 collagen) </li></ul><ul><li>Calcium and phosphate (calcium hydroxyapatite) </li></ul><ul><li>Osteoclasts are multi-nucleated cells which resorb bone (PTH). </li></ul> Introduction: <ul><li>Bone is a dynamic tissue - </li></ul><ul><li>Osteoblasts - osteoid (type 1 collagen) </li></ul><ul><li>Calcium and phosphate (calcium hydroxyapatite) </li></ul><ul><li>Osteoclasts are multi-nucleated cells which resorb bone (PTH). </li></ul>

    bone anatomy ul li diaphysis

    . Bone Anatomy <ul><li>Diaphysis </li></ul><ul><li>Metaphysis </li></ul><ul><li>Epiphysis – Prox/Dist </li></ul><ul><li>Epiphyseal line </li></ul><ul><li>Periosteum </li></ul><ul><li>Compact cortical bone </li></ul><ul><li>Spongy bone </li></ul><ul><li>Articular Cartilage </li></ul><ul><li>Medullary cavity </li></ul><ul><li>Marrow </li></ul><ul><li>Nutrient artery </li></ul>

    bone tissue ul li woven bone irregular immature

    . Bone tissue: <ul><li>Woven bone – Irregular, immature, fetus / growth plate / fracture. </li></ul><ul><li>Lamellar bone – regular – mature. </li></ul><ul><ul><li>Compact Bone. </li></ul></ul><ul><ul><ul><li>Circumferential </li></ul></ul></ul><ul><ul><ul><li>Concentric </li></ul></ul></ul><ul><ul><ul><li>Interstitial </li></ul></ul></ul><ul><ul><li>Spongy Bone </li></ul></ul><ul><ul><ul><li>Trabecular </li></ul></ul></ul><ul><li>Ossification: Formation of bone. </li></ul><ul><ul><li>Enchondral (long) / Intramembranous (flat) </li></ul></ul><ul><li>Osteoid: – protein mould of future bone. </li></ul>

    cancellous bone polarization m osteocyte lamellae

    . Cancellous bone: (Polarization.M) Osteocyte Lamellae

    bone histology lines of stress black arrows

    . Bone histology: lines of stress: (Black arrows)

    compact bone ul li osteons or haversian systems

    . Compact Bone: <ul><li>Osteons or Haversian systems. </li></ul><ul><ul><li>blood vessels, lymphatics & nerves. </li></ul></ul><ul><ul><li>osteocytes & in rings of calcified matrix. </li></ul></ul><ul><li>Osteons are aligned to lines of stress. </li></ul><ul><li>In spongy bone: (Trabecular) Lamellae are present but no osteons (& blood vessels). </li></ul>

    the matrix of bone ul li calcium hydroxyapatite

    . The matrix of bone : <ul><li>Calcium Hydroxyapatite in collagen framework – RCC* </li></ul><ul><li>Minerals  hardness </li></ul><ul><li>Collagen fibres  Tensile strength. </li></ul><ul><li>Osteoblasts - Calcification - Mineralization </li></ul><ul><li>Collagen & matrix (osteoid) is necessary for Calcification. </li></ul>

    bone is dynamic cont remodeling ul li 5 10 year

    . Bone is dynamic  cont. remodeling <ul><li>5-10% / year </li></ul><ul><li>Vitamin D </li></ul><ul><li>Nutrition </li></ul><ul><li>Physical activity </li></ul><ul><li>Age, hormones </li></ul><ul><li>PTH, PHRP </li></ul><ul><li>IL1, TNF,TGF- β </li></ul>

    osteoblasts osteocytes in osteoid osteocyte

    . Osteoblasts & Osteocytes in Osteoid: Osteocyte Osteoblasts Osteoid

    osteoblasts osteoid osteocyte osteoblasts osteoid

    . Osteoblasts & Osteoid: Osteocyte Osteoblasts Osteoid

    bone review ul li bone function

    . Bone Review: <ul><li>Bone Function: </li></ul><ul><ul><li>Anatomy </li></ul></ul><ul><ul><li>Mineral homeostasis. </li></ul></ul><ul><ul><li>Hemopoiesis. </li></ul></ul><ul><li>Ossification/Calcification </li></ul><ul><ul><li>Intramembranous </li></ul></ul><ul><ul><li>Endochondral </li></ul></ul>Key Words: Mineralization Calcification Ossification Osteoid Tensile strength Volkmann’s canal Haversian canal Lacunae Osteon Compact bone Trabecular bone

    obstacles cannot crush me every obstacle yields

    . Obstacles cannot crush me. Every obstacle yields to stern resolve. -Leonardo da Vinci

    pathology of bone fracture healing dr venkatesh 1

    . Pathology of Bone Fracture & Healing Dr. Venkatesh M. Shashidhar Senior Lecturer & Head of Pathology

    fractures ul li discontinuity in the bone

    . Fractures: <ul><li>Discontinuity in the bone. </li></ul><ul><li>Simple / Compound. </li></ul><ul><li>Horizontal, oblique, spiral, </li></ul><ul><li>Comminuted – multiple. </li></ul><ul><li>Greenstick – partial, usually in children. </li></ul><ul><li>Torus – compression of cortex – children. </li></ul><ul><li>Colle's fracture ? </li></ul>

    an individual at prolonged bed rest quickly

    . An individual at prolonged bed rest quickly begins to lose bone mineral density (BMD). Conversely, physical activity increases BMD . Use it or Loose it….!

    fracture types transverse spiral oblique linear

    . Fracture Types: Transverse Spiral Oblique Linear

    fracture types pott s incomplete impacted green

    . Fracture Types: Pott’s Incomplete Impacted Green stick

    fracture healing 1 day 1 3 week soft 6 weeks hard

    . Fracture Healing: 1 day 1-3 Week (Soft) 6 Weeks (Hard) >8 Weeks

    stages of fracture healing ul li 1day hematoma

    . Stages of fracture healing: <ul><li>1Day - Hematoma </li></ul><ul><ul><li>Blood clot, fibrin mesh – provide frame support. </li></ul></ul><ul><li>3Day-1wk - Inflammation </li></ul><ul><ul><li>Inflammatory cells infiltrate the wound. PDGF, IL, TGF etc.. Factors promote proliferation of stroma. </li></ul></ul><ul><li>1-3 Week - Soft callus. </li></ul><ul><ul><li>granulation tissue- Fibroblasts & endothelial cell proliferation with osteoid deposition. </li></ul></ul><ul><li>3-6 Week – Hard Callus </li></ul><ul><ul><li>– Mineralization of osteoid, ca+, woven bone forms. </li></ul></ul><ul><li>8Week+ - Re-modeling </li></ul><ul><ul><li>resorption/deposition along lines of stress. Lamellation & osteon formation. </li></ul></ul>

    bone healing callus fracture fibula 6 weeks later

    . Bone healing - Callus Fracture Fibula 6 weeks later Callus Fracture

    ul li irregular osteoid trabeculae

    . <ul><li>Irregular osteoid trabeculae </li></ul><ul><li>Lack of lamellae. </li></ul><ul><li>Prominent lining by osteoblasts. </li></ul><ul><li>Irregularly arranged osteocytes. </li></ul>Callus – Woven bone

    fracture with callus ul li fractured bone ends

    . Fracture with Callus <ul><li>Fractured bone ends. </li></ul><ul><li>Osteoid (note surrounding plump osteoblasts) </li></ul><ul><li>Granulation tissue </li></ul>

    fracture with callus ul li fractured bone ends 1

    . Fracture with Callus <ul><li>Fractured bone ends. </li></ul><ul><li>Granulation tissue </li></ul><ul><li>Woven bone (callus) </li></ul>

    factors affecting bone healing ul li local

    . Factors affecting Bone Healing: <ul><li>Local factors </li></ul><ul><li>Immobilization * </li></ul><ul><li>Improper reduction – abnormal position </li></ul><ul><li>Infection. Debris, dead tissue in wound </li></ul><ul><li>Joint involvement </li></ul><ul><li>Damage to nerves / blood vessels. </li></ul><ul><li>Bone pathology – tumors, osteoporosis, etc. </li></ul><ul><li>Systemic Factors </li></ul><ul><li>Age* </li></ul><ul><li>Nutrition – vitamin /mineral deficiency. </li></ul><ul><li>Immune status. </li></ul><ul><li>Systemic Diseases </li></ul><ul><ul><li>Chronic disease </li></ul></ul><ul><ul><li>Diabetes* </li></ul></ul><ul><li>Drugs – steroids. </li></ul><ul><li>Genetic disorders </li></ul><ul><ul><li>Haemophilia etc.. </li></ul></ul>

    complications ul li short term

    . Complications: <ul><li>Short Term: </li></ul><ul><li>Haemorrhage, Vascular injury* </li></ul><ul><li>Nerve / Visceral Injury* </li></ul><ul><li>Crush Syndrome* </li></ul><ul><li>Fat embolism </li></ul><ul><li>Renal failure </li></ul><ul><li>Shock, DIC. </li></ul><ul><li>Thromboembolism </li></ul><ul><li>Infection – Septicemia </li></ul><ul><li>Tetanus, Gas Gangrene </li></ul><ul><li>Long Term: </li></ul><ul><li>Delayed union </li></ul><ul><li>Non-union </li></ul><ul><li>Mal-union – deformity. </li></ul><ul><li>Growth disturbances </li></ul><ul><li>Contractures </li></ul><ul><li>Avascular Necrosis. </li></ul><ul><li>Osteomyelitis </li></ul><ul><li>Pseudoarthrosis </li></ul><ul><li>Osteoarthritis. </li></ul>

    crush syndrome ul li increase in osteofascial

    . Crush Syndrome: <ul><li>Increase in osteofascial compartments pressure leading to Muscle ischemia / necrosis – may lead to limb amputation </li></ul><ul><li>Signs: </li></ul><ul><ul><li>Pain, Swelling, Inflammation, mottling (necrosis) and blisters. </li></ul></ul><ul><li>Complications: </li></ul><ul><ul><li>Acute Renal failure (Low-output uraemia with acidosis) </li></ul></ul><ul><ul><li>DIC </li></ul></ul><ul><ul><li>Rhabdomyolysis </li></ul></ul>

    complications of ul li this is a photograph

    . Complications of # <ul><li>This is a photograph of the left calf showing 30° equinus deformity and severe scarring to the back of the lower leg. This was due to a severe soft tissue injury with ischaemia of the calf muscles and infection. Note the split skin grafting of the lesion. </li></ul>

    pseudoarthrosis ul li established non union

    . Pseudoarthrosis <ul><li>Established non union of the mid shaft of the humerus of several years duration. </li></ul><ul><li>It was forming a mobile painless pseudarthrosis which he was using as an effective elbow joint. His actual elbow joint was completely stiff. No treatment was indicated. </li></ul>

    cubitus valgus deformity ul li cubitus valgus

    . Cubitus valgus deformity: <ul><li>Cubitus valgus deformity due to a fracture of the lower humerus 3 years previously. </li></ul><ul><li>Gradually increasing due to damaged lateral & continued growth of medial epiphysis. </li></ul><ul><li>Also note late or tardy ulnar nerve palsy. </li></ul>

    bone necrosis sequestrum involucrum sequestrum

    . Bone necrosis, Sequestrum - involucrum Sequestrum - Involucrum Sequestrum

    cpc4 3 4 core learning issues ul li pathology 1

    . CPC4.3.4- Core learning Issues… <ul><li>Pathology - Core Learning Issues: </li></ul><ul><ul><li>Pathology of fractures, fracture healing * </li></ul></ul><ul><ul><li>Pathology – review of trauma, Tissue injury & Wound healing in special tissues. </li></ul></ul><ul><ul><li>Pathology of chest injury – lung collapse, surgical emphysema, </li></ul></ul><ul><ul><li>Pathology of splenic rupture. </li></ul></ul>

    summary further reading ul li bone types

    . Summary & Further Reading: <ul><li>Bone types, histology, formation, </li></ul><ul><li>Osteons, HS, lacunae, lamellae </li></ul><ul><li>Calcium, PO 4 ,Vit D, PTH & Calcitonin, </li></ul><ul><li>Healing - stages, factors (local/systemic) , complications (short/long term) </li></ul><ul><li>Pseudoarthrosis, involucrum, osteomyelitis. </li></ul><ul><li>Systemic Bone Diseases: </li></ul><ul><li>Osteoporosis, Osteomalacia & Rickets </li></ul>

    he who is fixed to a star does not change

    . He who is fixed to a star does not change his mind because of rough road. -Leonardo da Vinci

    cpc 3 4 mss trauma ul li pathology core learning

    . CPC-3.4– MSS - Trauma <ul><li>Pathology - Core Learning Issues: </li></ul><ul><ul><li>Pathology of trauma, Tissue injury & Wound healing </li></ul></ul><ul><ul><li>Fractures, fracture healing </li></ul></ul><ul><ul><li>Pathology of chest injury. </li></ul></ul><ul><ul><li>Pathology of splenic rupture </li></ul></ul><ul><li>Basic science - Core Learning Issues: </li></ul><ul><ul><li>Over view of tissue injury & Healing. </li></ul></ul><ul><ul><li>Metabolic response to trauma </li></ul></ul><ul><ul><li>Shock types and Pathophysiology. </li></ul></ul><ul><ul><li>Hypovolaemic shock </li></ul></ul><ul><ul><li>Limb anatomy : nerves, vessels & muscle functions. </li></ul></ul>

    what nerve injury ul li radial li ul ul li median

    . What Nerve Injury? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>

    what nerve injury ul li radial li ul ul li median 1

    . What Nerve Injury? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>

    what nerve injury ul li radial li ul ul li median 2

    . What Nerve Injury? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>

    fracture ul li scaphoid radius li ul ul li radius

    . Fracture ? <ul><li>Scaphoid & radius </li></ul><ul><li>Radius & metacarpel </li></ul><ul><li>Ulna & Metacarpel </li></ul><ul><li>Colle’s & metacarpel </li></ul><ul><li>Ulna & metacarpel </li></ul>

    16y boy fracture diagnosis ul li mature spongy

    . 16y Boy, fracture. ? Diagnosis <ul><li>Mature spongy bone. </li></ul><ul><li>Woven bone. </li></ul><ul><li>Granulation tissue. </li></ul><ul><li>Osteomyelitis. </li></ul><ul><li>Osteosarcoma. </li></ul>A B

    16y boy bone identify structure a ul li endosteum

    . 16y Boy, bone, Identify structure A: <ul><li>Endosteum. </li></ul><ul><li>Central canal. </li></ul><ul><li>Bone marrow. </li></ul><ul><li>Osteocytes. </li></ul><ul><li>Lamellae. </li></ul>A B C B

    what nerve injury ul li radial li ul ul li median 3

    . What Nerve Injury? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>

    which nerve injury is most likely ul li radial

    . Which nerve injury is most likely? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>

    28y man increasing back pain hat size ul li soft

    . 28y man, increasing back pain & hat size! <ul><li>Soft callus fracture. </li></ul><ul><li>Hard callus fracture. </li></ul><ul><li>Osteoporosis. </li></ul><ul><li>Paget’s disease. </li></ul><ul><li>Osteosarcoma. </li></ul>

    fracture type of tissue ul li soft callus

    . Fracture ? Type of tissue <ul><li>Soft callus </li></ul><ul><li>Trabecular bone </li></ul><ul><li>Woven bone </li></ul><ul><li>Spongy bone </li></ul><ul><li>Osteoid matrix </li></ul>

    28y man leg fracture identify b ul li mature

    . 28y man, Leg fracture. Identify ‘B’ <ul><li>Mature spongy bone </li></ul><ul><li>Woven bone </li></ul><ul><li>Granulation tissue </li></ul><ul><li>Osteoblasts </li></ul><ul><li>Osteoclast </li></ul>A B C D E

    fracture identify structure b ul li mature bone

    . Fracture ? Identify structure B <ul><li>Mature bone </li></ul><ul><li>Granulation tissue </li></ul><ul><li>Osteoid tissue </li></ul><ul><li>Macrophages </li></ul><ul><li>Osteoblasts. </li></ul>

    fracture expected complications

    . Fracture ? Expected complications <ul><li>Fat embolism </li></ul><ul><li>Mal union </li></ul><ul><li>Bone Necrosis </li></ul><ul><li>Radial nerve injury </li></ul><ul><li>All of the above </li></ul>

    pathology cli ul li pathology major

    . Pathology CLI: <ul><li>Pathology Major CLI: </li></ul><ul><ul><li>Pathology of Trauma – Fractures types, complications & bone healing. </li></ul></ul><ul><ul><li>Head injury – Pathology, Pathogenesis & clinical features. </li></ul></ul><ul><ul><li>Over view of Tumors of connective tissue – Osteosarcoma. (Web CPC 8) </li></ul></ul><ul><li>Pathology Minor CLI: </li></ul><ul><ul><li>Burns – Pathophysiology. </li></ul></ul><ul><ul><li>Blunt abdominal injury, spleen rupture. </li></ul></ul><ul><ul><li>Blunt and penetrating Chest injury, surgical emphysema, </li></ul></ul><ul><ul><li>Forensic Pathology – Gun shot, knife, electric, drowning. </li></ul></ul>

    cpc 3 4 kfp questions theme ul li types

    . CPC-3.4– KFP Questions/theme: <ul><li>Types of fractures. </li></ul><ul><li>Stages of Fracture healing – gross & Micro. </li></ul><ul><li>Factors affecting fracture healing – Local / systemic. </li></ul><ul><li>Complications of fractures. </li></ul><ul><li>Clinical & Pathology of specific organ trauma: Spine, chest, abdomen, spleen </li></ul><ul><li>Pathology of Crush syndrome. </li></ul><ul><li>Head injury: (covered separately) </li></ul>

    quot i learned that good judgment comes from

    . &quot;I learned that good judgment comes from experience and that experience grows out of mistakes .&quot; – Omar Bradley

    fracture complications ul li injury to posterior

    . ? Fracture - ? complications. <ul><li>Injury to Posterior tibial vessels and nerves. </li></ul><ul><li>Ischaemia / Infarction. </li></ul><ul><li>Paralysis of the foot. </li></ul><ul><li>Acute blood loss – shock </li></ul><ul><li>Crush syndrome </li></ul><ul><li>Renal Failure </li></ul><ul><li>Fat embolism. </li></ul><ul><li>Long term compl…? </li></ul>

    what nerve injury ul li radial li ul ul li median 4

    . What Nerve Injury? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>A median nerve palsy due to a wound on the palmar aspect of the wrist. This is causing wasting and paralysis of the thenar muscles.

    what nerve injury ul li radial li ul ul li median 5

    . What Nerve Injury? <ul><li>Radial </li></ul><ul><li>Median </li></ul><ul><li>Brachial </li></ul><ul><li>Axial </li></ul><ul><li>Ulnar </li></ul>Median nerve injuries lead to loss of wrist flexion strength, ulnar deviation of the wrist, loss of thumb opposition, and loss of finger flexion of the thumb, index and long finger interphalangeal joints.  When making a fist, the ring and small fingers flex while the long and index tend to stay straight.  In low median nerve injuries the fingers are still able to flex, but thumb opposition is often lost.

    fracture complications ul li median ulnar radial

    . ? Fracture ? complications <ul><li>Median, Ulnar, Radial neuropathy. </li></ul><ul><li>Radiocarpal arthrosis. </li></ul><ul><li>Mal position, Mal union </li></ul><ul><li>Tendon Ruptures </li></ul><ul><li>Finger stiffness. </li></ul><ul><li>Volkmann’s ischemia </li></ul><ul><li>Shoulder-hand syndrome* </li></ul>

    ul li may damage radial nerve

    . <ul><li>May damage radial nerve </li></ul><ul><li>If there is any doubt as to whether the nerve will recover, one should await for evidence of possible recovery of the nearest muscle supplied below the lesion. This is the brachioradialis with radial nerve injuries in the mid shaft of the humerus. The rate of possible regeneration of the nerve is assessed at 1mm a day or 3 cm (1 inch) a month plus an extra month. </li></ul>? Fracture ? complications

    trauma findings ul li the chest x ray showed

    . ? Trauma ? findings <ul><li>The Chest X-ray showed rupture of the left hemi-diaphragm with associated collapse of the left lung. The Chest X-ray showed rupture of the left hemi-diaphragm with associated collapse of the left lung. </li></ul>

    todays summary ul li trauma basic science

    . Todays Summary: <ul><li>Trauma – Basic Science, Pathology & Clinical & EPP& RR issues. </li></ul><ul><li>Anatomy </li></ul><ul><li>Circulation, shock, ischemia, infarction. </li></ul><ul><li>Tissue injury – Healing. </li></ul><ul><li>Bone Fractures – Bone Healing. </li></ul><ul><li>Stages, Factors affecting & Complications. </li></ul><ul><li>Abdominal, Thoracic Trauma. </li></ul><ul><li>Head injury – later.. </li></ul>

    spiritual wisdom all your suffering start with

    . Spiritual Wisdom All your suffering start with your desires. Stop desiring and you won't suffer. Jalaluddin Rumi

    82 22 female motorcycle accident internal

    82. 22 Female Motorcycle accident internal fixation was used after the fracture was reduced, and a Rush nail was inserted up the fibula to maintain alignment. Debridement and split skin grafting done. Surprisingly recovery… as no major vascular or nerve damage.

    83 spleen rupture ul li most common abdominal

    83. Spleen Rupture: <ul><li>Most common abdominal solid organ injury </li></ul><ul><li>Preexisting disease  markedly increase the risks & severity of splenic injury. </li></ul><ul><li>Preexisting infections or Splenomegaly  fragile, large with thin capsule  rupture. </li></ul><ul><li>Minor impact in patients with splenomegaly reportedly results in major injury and the need for splenectomy. </li></ul>

    84 blunt trauma ul li two thirds of the stomach

    84. Blunt Trauma: <ul><li>two-thirds of the stomach and the spleen had herniated through a 10cm diaphragm laceration into the chest. The stomach and spleen were reduced into the abdomen by extending the laceration laterally. </li></ul>

    85 trauma findings ul li a ct scan showed

    85. ?Trauma: ? findings <ul><li>A CT scan showed the stomach in the left thoracic cavity, and the rib fractures responsible for the diaphragmatic laceration: </li></ul>

    86 fracture complications what is this shadow

    86. ? Fracture ? complications  What is this shadow?

    87 ul li the collar cuff is supporting a fracture

    87. <ul><li>The collar cuff is supporting a fracture of the shaft of the humerus. The only absolute indication for a collar cuff sling in upper limb injuries is in humeral shaft fractures. This is because the weight of the arm help reduce the fracture and helps hold the fracture in alignment. </li></ul>? Fracture ? complications

    88 ul li you tell me now li ul ul li i don t know

    88. <ul><li>You tell me now, </li></ul><ul><li>I don’t know…!!! </li></ul>? Fracture ? complications

    89 ul li li ul fracture complications

    89. <ul><li>???? </li></ul>? Fracture ? complications

    90 ul li what level umn li ul ul li what level

    90. <ul><li>What level UMN ? </li></ul><ul><li>What level LMN ? </li></ul><ul><li>Urinary symptoms? </li></ul>? Fracture ? complications

    91 fracture complications ul li compound

    91. ? Fracture ? complications <ul><li>Compound Mid Shaft # Femur. </li></ul><ul><li>List complications shown in the image? </li></ul><ul><li>List Short term & Long term complications? </li></ul>

    93 fracture complications cervical spine c1 post

    93. ? Fracture ? complications Cervical spine - C1 post ring fracture right side. C2 fracture body with listhesis.

    94 spinal injuries ul li 3 major types cervical

    94. Spinal Injuries <ul><li>3 major types - Cervical, Thoracic and lumbar spine. </li></ul><ul><li>Cervical & lumbar region – Loose  less paralysis. </li></ul><ul><li>Stability of spine is due to supra & interspinous ligaments. </li></ul><ul><li>Thoracic region – Tight fit of cord – damage  paraplegia. </li></ul><ul><li>Injuries of cervical and thoracic cord  spastic paraplegia after the first 1 to 3 weeks of spinal shock have worn off. </li></ul><ul><li>Injuries to thoraco lumbar region  combined upper and lower motor type of paralysis. </li></ul><ul><li>Injuries of the cauda equina will cause a lower motor neurone paralysis as well as autonomic nerve damage. </li></ul>

    95 ignite the spark within your soul for it will

    95. Ignite the spark within your soul , for it will reveal that which is your truth . Ellie Crystal