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Clark's Positioning in Radiography
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109
4
Foot
Dorsi-plantar oblique
This projection allows the alignment of the metatarsals with thedistal row of th
e tarsus to be assessed.
Position of patient and cassette
From the basic dorsi-plantar position, the affected limb isallowed to lean media
lly to bring the plantar surface of thefoot approximately 30 45 degrees to the cas
sette.
A non-opaque angled pad is placed under the foot to main-tain the position, with
the opposite limb acting as a support.
Direction and centring of the X-ray beam
The vertical central ray is directed over the cuboid-navicular joint.
Essential image characteristics
The kVp selected should reduce the difference in subject con-trast between the t
hickness of the toes and the tarsus to give auniform radiographic contrast over
the range of foot densities.
A wedge filter may also be used to give a uniform range of densities.

The dorsi-plantar oblique should demonstrate the inter-tarsaland tarso-metatarsa


l joints.
Note
For non-ambulant/wheelchair-boundpatients, the cassette maybe placed on a pad or
stool directly in contact with the plantaraspect of the foot.
Radiological considerations
There are numerous possible accessory ossicles in the foot andaround the ankle,
as at the wrist. These may give rise to con-fusion with small avulsion injuries.
The base of the fifth metatarsal ossifies from the accessoryossification centre,
which is oriented parallel to the long axisof the bone. This should not be conf
used with a fracture,which usually runs transversely.
If the accessory ossification centre is not parallel to themetatarsal, then this
may be due to an avulsion injury.
Lisfranc fracture dislocations at the bases of the metatarsalsare difficult to s
ee, except on oblique projections, and will bemasked by underexposure.
Distal phalanxSesamoid bonesMetatarsals 1 to 5
Cuneiform bones
MedialIntermediateLateralNavicularTalonavicular jointHead of talusAnkle jointTib
iaFibulaCalcaneumCalcaneo-cuboid jointCuboid3rd tarso-metarsal jointBaseShaftHea
d
5th metatarsal
5th metatarso-phalangeal jointProximalMiddleDistal
Phalanges of 4th toeGreat toe (hallux)
Proximal phalanx
Normal dorsi-plantaroblique radiograph of footRadiographs showing normal fifth m
etatarsal ossification centreon the left, and fracture base fifth metatarsal on
right (arrow)
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4
Foot
Lateral
This is used in addition to the routine dorsi-planter projectionto locate a fore
ign body. It may also be used to demonstrate afracture or dislocation of the tar
sal bones, or base of metatarsalfractures or dislocation.
Position of patient and cassette
From the dorsi-plantar position, the leg is rotated outwardsto bring the lateral
aspect of the foot in contact with thecassette.
A pad is placed under the knee for support.
The position of the foot is adjusted slightly to bring the plan-tar aspect perpe
ndicular to the cassette.
Direction and centring of the X-ray beam
The vertical central ray is centred over the navicular cuneiform joint.
Essential image characteristics
If examining for a suspected foreign body, the kVp selectedshould be adequate to
show the foreign body against the soft-tissue structures.

Note
A metal marker placed over the puncture site is commonly usedto aid localization
of the foreign body.
110
Talonavicular jointNeck of talusTibiaFibulaPosterior
malleolus
of tibiaPosteriortalocalcaneal jointCalcaneumLongitudinalplantar archCuboidHead
of 5th metatarsalSesamoidbone of the halluxProximal and distalphalanges of theha
lluxNavicularMid-tarsal jointCuneiform bonesMetarsal bones
Normal lateral radiograph of footLateral radiograph of foot showing metallic for
eign body
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111
4
Foot
Lateral
erect
This projection is used to demonstrate the condition of the lon-gitudinal arches
of the foot, usually in pes planus (flat feet).Both feet are examined for compa
rison.
Position of patient and cassette
The patient stands on a low platform with a cassette placedvertically between th
e feet.
The feet are brought close together The weight of thepatient s body is distributed
equally.
To help maintain the position, the patient should rest theirforearms on a conven
ient vertical support, e.g. the verticalBucky.
Direction and centring of the X-ray beam
The horizontal central ray is directed towards the tubercle of the fifth metatar
sal.
Dorsi-plantar
erect
This projection can be used to show the alignment of themetatarsals and phalange
s in cases of hallux valgus. Bothforefeet are taken for comparison.
Position of patient and cassette
The patient stands with both feet on the cassette.
The cassette is positioned to include all the metatarsals andphalanges.
The weight of the patient s body is distributed equally.
To help maintain the position, the patient should rest the fore-arms on a conven
ient vertical support, e.g. the vertical Bucky.
Direction and centring of the X-ray beam
The vertical ray is centred midway between the feet at thelevel of the first met
atarso-phalangeal joint.
Dorsi-plantar erect projection of both feet showing hallux valgusNormal erect la
teral projection of foot

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4
Toes
Basic projections
It is common practice to obtain two projections, a dorsi-plantarand a dorsi-plan
tar oblique, using a 18
?
24-cm high-resolutioncassette. A lateral projection is taken for fractures of th
e halluxphalanx. A lead-rubber mask can be used to mask off each half of the cas
sette not in use.
Dorsi-plantar
basic
Position of patient and cassette
The patient is seated on the X-ray table, supported if neces-sary, with hips and
knees flexed.
The plantar aspect of the affected foot is placed on the cas-sette. This cassett
e may be supported on a 15-degree pad.
The leg may be supported in the vertical position by theother knee.
Direction and centring of the X-ray beam
The vertical central ray is directed over the third metatarso-phalangeal joint,
perpendicular to the cassette if all the toesare to be imaged.
For single toes, the vertical ray is centred over the metatarso-phalangeal joint
of the individual toe and collimated toinclude the toe either side.
Dorsi-plantar oblique
basic
Position of patient and cassette
From the basic dorsi-plantar position, the affected limb isallowed to lean media
lly to bring the plantar surface of thefoot approximately 45 degrees to the cass
ette.
A 45-degree non-opaque pad is placed under the side of thefoot for support, with
the opposite leg acting as a support.
Direction and centring of the X-ray beam
The vertical ray is centred over the first metatarso-phalangeal joint if all the
toes are to be imaged and angled sufficiently toallow the central ray to pass t
hrough the third metatarso-phalangeal joint.
For single toes, the vertical ray is centred over the metatarso-phalangeal joint
of the individual toe, perpendicular to thecassette.
112
Normal dorsi-plantar projection of all toesCollimated dorsi-plantar oblique proj
ection of fifth toe, showing fractureof the proximal phalanx
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113
4
Toes

Lateral (basic)
hallux
Direction and centring of the X-ray beam
The vertical ray is centred over the first metatarso-phalangeal joint.
First metatarsal-phalangealsesamoid bones
The sesamoid bones are demonstrated on the lateral foot projec-tion. However, wh
en requested specifically, a modified lateral andan axial projection may be nece
ssary for further demonstration.
Lateral
Position of patient and cassette
The patient lies on the unaffected side, and the medial aspect of the affected l
eg and foot is placed in contact with the table.
The cassette is placed under the foot to include the phalangesof the hallux and
the distal part of the first metatarsal.
The hallux is then dorsiflexed with the aid of a bandage andheld by the patient.
Direction and centring of the X-ray beam
Centre with the vertical ray perpendicular to the cassette,over the first metata
rso-phalangeal joint.
Axial
Position of patient and cassette
There is a choice of two positions for this projection:
1
The patient is positioned as for the lateral projection of thefoot. The foot is
raised on a support and the cassette is sup-ported vertically and well into the
instep. A horizontal beamis used in this case.
2
The patient sits on the X-ray table, with legs extended. Thehallux is then dorsi
flexed with the aid of a bandage and held bythe patient. The cassette is raised
on a support and positionedfirmly against the instep.
Direction and centring of the X-ray beam
Centre to the sesamoid bones with the central ray projectedtangentially to the f
irst metatarso-phalangeal joint.
Normal lateral basicprojection of halluxLateral projection of first metatarsalse
samoids, note exostosis onmedial sesamoidNormal axial projection of firstmetatar
sal sesamoids
Position of patient and cassette
From the dorsi-plantar position, the foot is rotated mediallyuntil the medial as
pect of the hallux is in contact with thecassette. A bandage is placed around th
e remaining toes (pro-vided that no injury is suspected) and they are gently pul
ledforwards by the patient to clear the hallux. Alternatively,they may be pulled
backwards; this shows the metatarso-phalangeal joint more clearly.
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UPLOADLIBRARY
BooksAudiobooks
DOWNLOADSTANDARD VIEWFULL VIEW
126
OF 532
8

Clark's Positioning in Radiography


Ratings: (1)|Views: 1,142|Likes: 4
Published by Daniel Duran
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109
4
Foot
Dorsi-plantar oblique
This projection allows the alignment of the metatarsals with thedistal row of th
e tarsus to be assessed.
Position of patient and cassette
From the basic dorsi-plantar position, the affected limb isallowed to lean media
lly to bring the plantar surface of thefoot approximately 30 45 degrees to the cas
sette.
A non-opaque angled pad is placed under the foot to main-tain the position, with
the opposite limb acting as a support.
Direction and centring of the X-ray beam
The vertical central ray is directed over the cuboid-navicular joint.
Essential image characteristics
The kVp selected should reduce the difference in subject con-trast between the t
hickness of the toes and the tarsus to give auniform radiographic contrast over
the range of foot densities.
A wedge filter may also be used to give a uniform range of densities.
The dorsi-plantar oblique should demonstrate the inter-tarsaland tarso-metatarsa
l joints.
Note
For non-ambulant/wheelchair-boundpatients, the cassette maybe placed on a pad or
stool directly in contact with the plantaraspect of the foot.
Radiological considerations
There are numerous possible accessory ossicles in the foot andaround the ankle,
as at the wrist. These may give rise to con-fusion with small avulsion injuries.

The base of the fifth metatarsal ossifies from the accessoryossification centre,
which is oriented parallel to the long axisof the bone. This should not be conf
used with a fracture,which usually runs transversely.
If the accessory ossification centre is not parallel to themetatarsal, then this
may be due to an avulsion injury.
Lisfranc fracture dislocations at the bases of the metatarsalsare difficult to s
ee, except on oblique projections, and will bemasked by underexposure.
Distal phalanxSesamoid bonesMetatarsals 1 to 5
Cuneiform bones
MedialIntermediateLateralNavicularTalonavicular jointHead of talusAnkle jointTib
iaFibulaCalcaneumCalcaneo-cuboid jointCuboid3rd tarso-metarsal jointBaseShaftHea
d
5th metatarsal
5th metatarso-phalangeal jointProximalMiddleDistal
Phalanges of 4th toeGreat toe (hallux)
Proximal phalanx
Normal dorsi-plantaroblique radiograph of footRadiographs showing normal fifth m
etatarsal ossification centreon the left, and fracture base fifth metatarsal on
right (arrow)
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4
Foot
Lateral
This is used in addition to the routine dorsi-planter projectionto locate a fore
ign body. It may also be used to demonstrate afracture or dislocation of the tar
sal bones, or base of metatarsalfractures or dislocation.
Position of patient and cassette
From the dorsi-plantar position, the leg is rotated outwardsto bring the lateral
aspect of the foot in contact with thecassette.
A pad is placed under the knee for support.
The position of the foot is adjusted slightly to bring the plan-tar aspect perpe
ndicular to the cassette.
Direction and centring of the X-ray beam
The vertical central ray is centred over the navicular cuneiform joint.
Essential image characteristics
If examining for a suspected foreign body, the kVp selectedshould be adequate to
show the foreign body against the soft-tissue structures.
Note
A metal marker placed over the puncture site is commonly usedto aid localization
of the foreign body.
110
Talonavicular jointNeck of talusTibiaFibulaPosterior
malleolus
of tibiaPosteriortalocalcaneal jointCalcaneumLongitudinalplantar archCuboidHead
of 5th metatarsalSesamoidbone of the halluxProximal and distalphalanges of theha

lluxNavicularMid-tarsal jointCuneiform bonesMetarsal bones


Normal lateral radiograph of footLateral radiograph of foot showing metallic for
eign body
You're Reading a Free Preview
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111
4
Foot
Lateral
erect
This projection is used to demonstrate the condition of the lon-gitudinal arches
of the foot, usually in pes planus (flat feet).Both feet are examined for compa
rison.
Position of patient and cassette
The patient stands on a low platform with a cassette placedvertically between th
e feet.
The feet are brought close together The weight of thepatient s body is distributed
equally.
To help maintain the position, the patient should rest theirforearms on a conven
ient vertical support, e.g. the verticalBucky.
Direction and centring of the X-ray beam
The horizontal central ray is directed towards the tubercle of the fifth metatar
sal.
Dorsi-plantar
erect
This projection can be used to show the alignment of themetatarsals and phalange
s in cases of hallux valgus. Bothforefeet are taken for comparison.
Position of patient and cassette
The patient stands with both feet on the cassette.
The cassette is positioned to include all the metatarsals andphalanges.
The weight of the patient s body is distributed equally.
To help maintain the position, the patient should rest the fore-arms on a conven
ient vertical support, e.g. the vertical Bucky.
Direction and centring of the X-ray beam
The vertical ray is centred midway between the feet at thelevel of the first met
atarso-phalangeal joint.
Dorsi-plantar erect projection of both feet showing hallux valgusNormal erect la
teral projection of foot
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4
Toes
Basic projections
It is common practice to obtain two projections, a dorsi-plantarand a dorsi-plan
tar oblique, using a 18

?
24-cm high-resolutioncassette. A lateral projection is taken for fractures of th
e halluxphalanx. A lead-rubber mask can be used to mask off each half of the cas
sette not in use.
Dorsi-plantar
basic
Position of patient and cassette
The patient is seated on the X-ray table, supported if neces-sary, with hips and
knees flexed.
The plantar aspect of the affected foot is placed on the cas-sette. This cassett
e may be supported on a 15-degree pad.
The leg may be supported in the vertical position by theother knee.
Direction and centring of the X-ray beam
The vertical central ray is directed over the third metatarso-phalangeal joint,
perpendicular to the cassette if all the toesare to be imaged.
For single toes, the vertical ray is centred over the metatarso-phalangeal joint
of the individual toe and collimated toinclude the toe either side.
Dorsi-plantar oblique
basic
Position of patient and cassette
From the basic dorsi-plantar position, the affected limb isallowed to lean media
lly to bring the plantar surface of thefoot approximately 45 degrees to the cass
ette.
A 45-degree non-opaque pad is placed under the side of thefoot for support, with
the opposite leg acting as a support.
Direction and centring of the X-ray beam
The vertical ray is centred over the first metatarso-phalangeal joint if all the
toes are to be imaged and angled sufficiently toallow the central ray to pass t
hrough the third metatarso-phalangeal joint.
For single toes, the vertical ray is centred over the metatarso-phalangeal joint
of the individual toe, perpendicular to thecassette.
112
Normal dorsi-plantar projection of all toesCollimated dorsi-plantar oblique proj
ection of fifth toe, showing fractureof the proximal phalanx
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113
4
Toes
Lateral (basic)
hallux
Direction and centring of the X-ray beam
The vertical ray is centred over the first metatarso-phalangeal joint.
First metatarsal-phalangealsesamoid bones
The sesamoid bones are demonstrated on the lateral foot projec-tion. However, wh
en requested specifically, a modified lateral andan axial projection may be nece
ssary for further demonstration.
Lateral
Position of patient and cassette

The patient lies on the unaffected side, and the medial aspect of the affected l
eg and foot is placed in contact with the table.
The cassette is placed under the foot to include the phalangesof the hallux and
the distal part of the first metatarsal.
The hallux is then dorsiflexed with the aid of a bandage andheld by the patient.
Direction and centring of the X-ray beam
Centre with the vertical ray perpendicular to the cassette,over the first metata
rso-phalangeal joint.
Axial
Position of patient and cassette
There is a choice of two positions for this projection:
1
The patient is positioned as for the lateral projection of thefoot. The foot is
raised on a support and the cassette is sup-ported vertically and well into the
instep. A horizontal beamis used in this case.
2
The patient sits on the X-ray table, with legs extended. Thehallux is then dorsi
flexed with the aid of a bandage and held bythe patient. The cassette is raised
on a support and positionedfirmly against the instep.
Direction and centring of the X-ray beam
Centre to the sesamoid bones with the central ray projectedtangentially to the f
irst metatarso-phalangeal joint.
Normal lateral basicprojection of halluxLateral projection of first metatarsalse
samoids, note exostosis onmedial sesamoidNormal axial projection of firstmetatar
sal sesamoids
Position of patient and cassette
From the dorsi-plantar position, the foot is rotated mediallyuntil the medial as
pect of the hallux is in contact with thecassette. A bandage is placed around th
e remaining toes (pro-vided that no injury is suspected) and they are gently pul
ledforwards by the patient to clear the hallux. Alternatively,they may be pulled
backwards; this shows the metatarso-phalangeal joint more clearly.
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1
!Emergeortho procedures
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Published by Georgios Mandelas
about ortho procedures
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8Emergency Room Orthopaedic Procedures
St
ep 5: Wrist Block-Radial Nerve
Pronate the hand and place it on a sterile drape.
Insert the needle 2 cm proxima
l to the tip of the radial styloid along the radial aspect of the distal forearm
(Fig. 1.6). Inject 7 to
10 cc of anesthetic along the radial and dorsal aspect of the wrist and distal f
orearm, between the ?rst and third dorsal compart-ments (the tendons of the abdu
ctor pollicis longus, and extensor pollicis brevis and the extensor pollicis lon
gus).
SUGGESTED READINGS
1. Chale S, Singer AJ, Marchini S, et al. Digital versus local anesthesia for ?n
ger lacerations: A randomized controlled trial. Academic Emergency
Medicine. 2006;13(10):1046-50.
2. Chiu D?. ?ransthecal digital block: Flexor tendon sheath used for anesthetic infusion. J Hand Surg Am. 1990;15(3):471-3.4.
3. Egol Kenneth A, Kenneth J Koval, Joseph D Zuckerman. Handbook of
Fractures, 4th edn. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. pp. 6
8-9.
Fig. 1.6 Super?cial radial nerve block performed by injecting local anes
thetic 2 cm proximal to the tip of the radial styloid along the radial aspect
of the distal forearm
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Nerve Blocks Around the Hand9


4. Setnik and Tomson Associates. Local anesthesia techniques [online]. Te Multim
edia Procedure Manual. Available from http://emproce-dures.com/anesthesia/pharma
cology.htm5. Whetzel ?P, Mabourakh S, Barkhordar R. Modi?ed transthecal digital
block. J Hand Surg Am. 1997;22(2):361-3. 6. Yin ZG, Zhang JB, Kan SL, et al. A c
omparison of traditional digital
blocks and single subcutaneous palmar injection blocks at the base of the ?nger
and a meta-analysis of the digital block trials. Journal of Hand
Surgery (British and European Volume). 2006;31(5):547-55.
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INTRODUCTION
Ankle fractures, commonly present to the emergency department, following injuri
es sustained during athletic participation or from higher energy traumatic event
s. Tey account for 12 percent of all bony injuries and often are the result of a
rotational mechanism. Important factors in?uencing the type of ankle fracture s
ustained include the patient s age, bone quality, position of the foot at the time
of injury, and the magnitude, direction and rate of the force applied. Te follo
wing chapter will review the relevant anatomy, methods of evaluation, classi?cat
ion and techniques for both frac-ture reduction and splinting.
RELEVANT ANATOMY
?he ankle is a hinge or saddle-type joint, composed of the distal tibia, the dis
tal fibula and the dome of the talus. ?he articular surface of the distal tibia
(the plafond) combined with the medial and lateral malleoli form the ankle morti
se, which is a constrained articulation for the talar dome. ?he dome of the talu
s is approxi-mately 2.5 mm wider anteriorly than it is posteriorly, helping prov
ide ankle stability in the dorsiflexed position during weight-bearing activities
.
Eric J Strauss
The Evaluation and Management of Ankle Fractures: Reduction and Splinting Techni
ques
2
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The Evaluation and Management of Ankle Fractures11
Te ankle is supported by a system of ligamentous structures including the anteri
or talo?bular ligament (A?FL), posterior talo?b-ular ligament (P?FL) and calcane
o?bular ligament (CFL) laterally, and the deltoid ligament complex medially (com
posed of a super?-cial portion and a deep intra-articular portion). Additional s
upport is provided by the syndesmotic ligament complex, which provides resistanc
e to rotational, axial and translational forces by connecting the distal tibia a
nd ?bula (Fig. 2.1). Te syndesmosis is comprised of the anterior inferior tibio?
bular ligament (AI?FL), the posterior inferior tibio?bular ligament (PI?FL), the
transverse tibio?bular ligament and the interosseous ligament which is a distal
extension of the syndesmotic membrane. Functionally, ankle motion occurs in dor
si?exion and plantar ?exion, with 30 of dorsi?exion and 45 of plantar ?exion, is c
onsid-ered normal. Inversion and eversion of the ankle takes place at the level
of the subtalar joint, formed at the articulation of the talus and the calcaneus
. Secondary to the strength of the ligamentous struc-tures supporting the subtal
ar joint, inversion and eversion forces tend to cause injury to the structural c
omponents of the ankle joint.
Fig. 2.1

Te ankle joint is stabilized by its supporting ligaments in-cluding the anterior


talo?bular ligament (A?FL), posterior talo?bular ligament (P?FL) and calcaneo?b
ular ligament (CFL) laterally and the deltoid ligament complex medially.
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12Emergency Room Orthopaedic Procedures
PRESENTATION AND EVALUATION IN THE EMERGENCY ROOM
Patients with ankle fractures typically present to the ER with complaints of pai
n, swelling and di?culty with weightbearing activ-ities following a rotational t
ype mechanism of injury (Fig. 2.2). Tey may have gross deformity present which s
hould alert the evaluating physician to the possibility of a fracture dislocatio
n. Some patients may be capable of weightbearing with discomfort despite the pre
s-ence of bony injury while others may be unable to bear any weight at all on th
e injured lower extremity.Te initial evaluation includes an inspection of the in
jured ankle, noting the presence of deformity and the condition of the surroundi
ng soft tissue, looking for evidence of an open injury or the presence of bliste
ring. A careful neurovascular examination should be performed and documented in
the patient s chart. Next, the entire length of the ?bula should be palpated for
tenderness and the presence of a bony step-o?, indicative of a displaced fractur
e. Palpation of the ankle should
Fig. 2.2
Patient who presented to the emergency room with a left ankle fracture. Note the
ecchymosis and swelling present about the lateral aspect of the ankle in the re
gion of the lateral malleolus
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The Evaluation and Management of Ankle Fractures13
be continued medially, looking for tenderness over the medial malle-olus and the
deltoid ligament complex. A squeeze test can then be performed by squeezing 5 cm
proximal to the intermalleolar line to identify a possible injury to the syndesm
osis.
RADIOGRAPHIC EVALUATION
A three-view series of the ankle is typically utilized for the diagnosis of ank
le fractures in the ER. Tis series is composed of an anteroposte-rior (AP) view,
a lateral view and a mortise view (Figs 2.3A-C).
Figs 2.3A-C An ankle trauma X-ray series of the right ankle showing evidence of
displaced bimalleolar ankle fracture (A) Anteroposterior; (B) Mortise; (C) Later
al
A BC
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Basic Surgical Skills Manual
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Published by Valerie Gonzaga
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BASIC SURGICAL SKILLS MANUAL
Principles and Applications
2nd Edition
Electronic Version
PHILIPPINE COLLEGE OF SURGEONS
Committee on Surgical Training
Cenon R. Alfonso
, MD - Committee Chairman
Miguel C. Mendoza
, MD - Editor-in-Chief
Shirard L.C. Adiviso
, MD,
Jose Joey H. Bienvenida
, MD,and
Renato Cirilo A. Ocampo
, MD
Armando C. Crisostomo
, MD - Regent-in-Charge.
PCS S
CIENTIFIC
P
UBLICATION
N
O
. 12
Foreword
2nd Edition . . .
Cenon R. Alfonso
, MD, FPCS, ChairmanCommittee on Surgical Training, Philippine College of Surgeo
ns2003
Foreword
1st Edition . . .
Gabriel L. Martinez
, MD, FPCS, Chairman,Committee on Surgical Training, Philippine College of Surge
ons1999
Message from the 2003 PCS President

Fernando A. Lopez
, MD, FPCS
Preface
2nd Edition . . .
Armando C. Crisostomo
, MD, FPCS,Regent-In-Charge (2003), Committee on Surgical Training,Philippine Co
llege of Surgeons
Preface
1st Edition . . .
Jose Y. Cueto
, MD, FPCS, Regent-In-Charge(1999), Committee on Surgical Training, Philippine C
ollege ofSurgeons
?
Chapter I
Learning & Assessing Psychomotor Skills inSurgery
Jose Y. Cueto, Jr.
, MD, MHPEd, FPCS (1st edition) Self-Assessment Questions
?
Chapter II
The Use of Simulation in Surgical Training
Shirard L.C. Adiviso
, MD, MHPEd, FPCS Self-assessment Questions
?
Chapter III
Suture Materials
Jose Antonio M. Salud
, MD, FPCS and
Jerome G. Baldonado
, MD, FPCS (1st edition)
Joey H. Bienvenida
, MD, FPCS (2nd edition) Self-assessment Questions
?
Chapter IV
Surgical Needles
Cenon R. Alfonso
, MD, FPCS and
Nilo C. de los Santos
, MD, FPCS (1st edition)
Renato A. Ocampo
, MD, FPCS (2nd edition) Self-assessment Questions
Table of Contents
?
Chapter V
Knot Tying
Jose Antonio M. Salud
, MD, FPCS (1st edition)
Miguel C. Mendoza
, MD, FPCS (2nd edition) Self-assessment Questions
?
Chapter VI
Suturing Techniques
Cenon R. Alfonso
, MD, FPCS,
Shirard L.C. Adiviso
, MD, MHPEd, FPCS,
Jose Joey H. Bienvenida
, MD, FPCS,
Miguel C. Mendoza
, MD, FPCS, and
Renato Cirilo A. Ocampo

, MD, FPCS (2nd edition) Self-assessment Questions


?
Chapter VII
Clinical Applications
Cenon R. Alfonso
, MD, FPCS,
Jerome G. Baldonado
, MD, FPCS,
Alejandro C. Dizon
, MD, FPCS,
Rene C. Encarnacion
, MD, FPCS,
Eduardo S. Eseque
, MD, FPCS,
Gabriel L. Martinez
, MD, FPCS,
Paul Jesus S. Montemayor
, MD, FPCS,
Jose Antonio M. Salud
, MD, FPCS, and
Jose A. Solomon
, MD, FPCS. Plastic Closure of Skin Lacerations Skin Closure with Skin Adhesives Abdom
inal Wall Closure Inguinal Herniorrhaphy/ Repair of the InguinalFloor Appendectomy Ch
olecystectomy & Surgery of the Bile Ducts Liver Trauma Bowel Anastomosis Vascular Anas
tomosis & Repair Application of Retention Sutures Self-assessment Questions
Appendix A
(Glossary of terms)
Appendix B
(Answers to self-assessment questions)
2003 PCS Board of Regents2003 Committee on Surgical TrainingAcknowledgement
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Diagnostic Anatomy Radiographic
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46
THE WHO MANUAL OF DIAGNOSTIC IMAGING

Radiocapitellar line
a line drawn along the centre of the shaft of the proximal radius should pass thr
ough the capitellum(?g 4.32). if the line does not pass through the capitellum the
n either the radial head or the capitellum isdisplaced (?g 4.33).
Figure 4.30
Anterior humeral line. Thenormal line bisects thecapitellum at the junctionof th
e anterior and middlethirds.(modi?ed from Lee Rogers
Radiology of Skeletal Trauma
2nd Ed, ChurchillLivingstone 1992)(a)(b)
Figure 4.31
Supracondylar fractures in children. (a) minimal displacement; (b) markeddisplac
ement. Note that the anterior humeral line is abnormal in both cases.
Figure 4.32
Normal radiocapitellar line on the AP and lateral views.(from Raby, Berman & de
Lacey,
Accident & Emergency Radiology: a survival guide
, Saunders, London, 1995,with permission)
Figure 4.33
There is a fracture of the proximal third of the ulna associatedwith dislocation
of the proximal radius. The radiocapitellarline is disrupted (Monteggia fractur
e).
TRAUMA
47
Supracondylar fractures
the commonest fracture of the elbow in children. transverse fracture of the distal
humeral metaphysis. Approximately 50% are greenstick fractures(?g 4.34). posterior
displacement of the distal fragment with the anterior humeral line passing thro
ugh theanterior third or completely anterior to the capitellum (?g 4.31) severely
displaced fractures may be associated with brachial artery compression.
Condylar and epicondylar fractures
there is a spectrum of avulsion injuries of the humeral condyles and epicondyles
ranging fromthose with only minor displacement to those with major displacement
(?gs 4.35 and 4.36).
Figure 4.34
Greenstick supracondylar fracture. Note that the anteriorhumeral line is normal.
Figure 4.35
Avulsion of the lateral epicondyle in a child with minordisplacement.
48
THE WHO MANUAL OF DIAGNOSTIC IMAGING
avulsion of the medial epicondyle may be displaced into the joint mimicking the t
rochlea ossi?cationcentre.
Capitellar fractures
commonest purely intra-articular fracture of the elbow. fracture usually identi?ed
on lateral projection with fragment rotating anteriorly (?g 4.37). AP ?lm may appe
ar normal or show increased density due to the capitellar fragment overlying the
lateral epicondyle.
(a)(b)
Figure 4.36
(a) avulsion of the lateral epicondyle in a child withmarked displacement.(b) th
e lateral projection shows the radiocapitellar lineis disrupted indicating that
there is a dislocation of thehead of radius as well as the avulsion fracture.
Figure 4.37
Fracture of the capitellum. The capitellumhas rotated 90 degrees anteriorly.
TRAUMA

49
Radial head fractures
account for approximately one third of all elbow fractures. commonest in young adul
ts. spectrum of injury from minimally displaced to comminuted with displacement (?
g 4.38). in children tend to appear as a greenstick fracture of the radial neck ra
ther than a fracture of theradial head (?g 4.39).
Figure 4.38
Fracture of the radial head with minordisplacement.
Figure 4.39
Greenstick fracture of the neck of radius in a child.
Olecranon fractures
result from either a direct blow to the tip of the elbow or avulsion by contracti
on of the tricepsmuscle against a ?xed ?exed elbow. the action of the triceps freq
uently causes marked displacement of the olecranon at the fracturesite (?g 4.40)
.
Figure 4.40
Displaced fracture of the olecranon.
50
THE WHO MANUAL OF DIAGNOSTIC IMAGING
Elbow dislocation
third commonest site of dislocation in the adult after shoulder and ?ngers. commone
st site of dislocation in children under 10 years of age. 85% posterior or postero
lateral in direction (?g 4.41). 50% associated with fractures (?g 4.42).
Figure 4.41
Posterior dislocation of the elbow. (a) AP (b) lateral view.(a)(b)(a)(b)
Figure 4.42
Posterior dislocation of the elbow with a displaced fracture of the radial head.
Note that because of the severe trauma it is notalways possible to obtain ideal
AP (a) and lateral projections (b).
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DERMAL INSTRUMENTS
47
SCHAMBERG COMEDONE EXTRACTOR
KM 29-580KM 29-5823
3
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UNNA COMEDONE EXTRACTOR
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KMEDIC COMEDONE EXTRACTOR
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GREG COMEDONE EXTRACTOR
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DERMAL INSTRUMENTS
48
KEYES PUNCH
4
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(102mm)KM 29-5112mmKM 29-5145mmKM 29-5123mmKM 29-5156mmKM 29-5134mmKM 29-5178mm
FOX CURETTE
5
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(140mm)roundKM 29-4951mmKM 29-4984mmKM 29-4962mmKM 29-4995mmKM 29-4973mmKM 29-50


06mm
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(140mm)ovalKM 29-503#1 smallKM 29-505#2 mediumKM 29-507#3 large
BIRO DERMAL NAEVUS SCISSORS
KM 35-5154
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(102mm) angled on flatsharp outside edges
NAIL SPLITTER
Note: For a sure grip, our splitters have grooved handles.

2mm3mm4mm5mm6mm8mm1mm2mm3mm4mm5mm6mm
1
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TISSUE NIPPERNAIL NIPPER
heavy
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EYE INSTRUMENTS
50
BARRAQUER EYE SPECULUM
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(44mm)KM 54-108KM 54-110small bladeslarge blades10mm wide15mm wide
GRAEFE EYE SPECULUM
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GRAEFE STRABISMUS HOOK
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(140mm)KM 54-330smallKM 54-332mediumKM 54-334large
BOWMAN LACRIMAL PROBES
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62KM 54-364
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EYE INSTRUMENTS
51
SCHIOTZ TONOMETER
KM 53-056straight scaleKM 53-058straight scale with Allen PlungerKM 53-060improv
ed, inclined scaleKM 53-062improved, inclined scale with Allen Plunger
CASTROVIEJO CALIPER
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(83mm) graduated 0-20mm


DIX SPUD AND NEEDLE
KM 54-272in reversible screw handle
FOREIGN BODY NEEDLES AND SPUDS

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(127mm)2 x 5mm blade
DAVIS
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(121mm)0.8mm blade
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EYE INSTRUMENTS
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BISHOP HARMAN FORCEPS
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8
?
(86mm)KM 53-426extra delicate serrated 0.7mmKM 53-428delicate serrated 1.0mmKM 5
3-440delicate 1x2 teeth 1.0mm
TROUTMAN-BARRAQUER FORCEPS
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Atlas of Emergency Trauma
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Atlas of Emergency Trauma
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4.1 Chest Wall, Soft Tissues
Seatbelt marks on the thoracic wall are indicatorsof severe trauma, and 20% of t
hese patients havesigni?cant intrathoracic injuries. These patientsshould have r
outine evaluation for lung contu-sion, myocardial contusion, aortic rupture, and
hemopneumothorax.
4.2 Rib Fractures
Fractures of the Upper (First or Second) Ribs
Fractures of the upper ribs, especially the ?rst rib, areassociated with a high
incidence of subclavian andother major vascular injuries. A CTA or CFDevaluation
of the vessels will help exclude this injury.The force required to fracture an
upper rib is severe,and thus mediastinal structures, including the aorta,are als
o at high risk with this mechanism. Childrenhave a much more compliant chest wal
l, and thus anyrib fractures are signi?cant.
Figure 4.1 Chest seatbelt marks are markers of signi
??
cant internal injuries and should be evaluated by CT scan, ECG andtroponin level
s.Figure 4.2 Chest x-ray with fractures of the upper ribs. These cases should al
ways be evaluated for thoracic inlet vascular injuries, especially the subclavia
n vessels.
78 Thoracic Injury
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Fractures of Middle (Thirdto Eighth) Ribs
Rib fractures are diagnosed clinically (pain aggravatedby breathing or coughing,
pain on anteroposteriorchest compression) or radiologically. Fractures atthe co
stochondral junction may not show on x-rays.Associated injuries include hemopneu
mothorax, lungcontusion, cardiac trauma, and diaphragmatic tear.Pain relief is e
xtremely important, especially in eld-erly patients with multiple rib fractures,
in order toprevent atelectasis and pneumonia. PCA or epiduralanalgesia should b
e considered in multiple fractures.Rib fractures in children are uncommon and si
gnifysevere impact to the chest wall, and there is a highincidence of underlying
lung contusion.
ABC
Figure 4.3 (A
B) Plain radiographs of multiple mid rib fractures, with underlying lung contusi
on (A). Adequate analgesiawith epidural or patient-controlled analgesia should b
e considered early, especially in elderly patients. (C) 3-D reconstructionof mul
tiple mid rib fractures and a thoracostomy tube in place.
4.2 Rib Fractures 79
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Fractures of the Lower (Ninthto Twelfth) Ribs
Fractures of the lower ribs are often associated withinjuries to the kidneys, li
ver, or spleen. Liberal use of abdominal CT scan should be considered.
Flail Chest
Flail chest is the result of anterior or lateraldouble fractures of at least thr
ee adjacent ribs. Inmost cases there is an underlying lung contusion.Clinically
the ?ail segment moves paradoxically to

Figure 4.4 (A) Radiograph showing fractures of the right lower ribs (arrows) (le
ft). Injuries to intra-abdominal solid organsare common and CT scan evaluation s
hould be considered. (B) Intraoperative photograph of the associated liver injur
yin the same patient.
AB
Figure 4.5 Flail chest. (A) Double fractures of at least three adjacent ribs are
required in order to produce a
??
ail chest.(B) Chest x-ray showing a left
??
ail chest with underlying lung contusion. (C) Patient with a
??
ail sternal segment; Note themidsternal depression (right).
80 Thoracic Injury
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normal chest wall motion, and the patient may bein respiratory distress. All pat
ients with ?ail chestshould have a thoracostomy tube inserted and bemonitored in
an ICU setting with serial blood gasesand continuous pulse oximetry. Analgesia
by meansof PCA or epidural anesthesia should always beused. Mechanical ventilati
on is necessary forrespiratory failure or imminent failure. Internal,operative f
racture ?xation may be useful in selectedcases without underlying lung contusion
and inpatients having dif?culty weaning off mechanicalventilation.
4.3 Hemo-Pneumothorax
Pneumothorax
A pneumothorax may be due to blunt or penetra-ting trauma. Small pneumothoraces
are usuallyasymptomatic and can safely be managed withouta chest drain, provided
the patient does not needmechanical ventilation or air transportation. Inthese
cases, any size pneumothorax should betreated with a thoracostomy tube to avoid
thecreation of tension pneumothorax. Large pneu-mothoraces may cause respiratory
distress, andtension pneumothoraces can cause cardiorespira-tory failure. The d
iagnosis of simple pneumo-thorax is usually made by plain chest ?lm orCT scan. A
n erect chest x-ray in deep expirationis the most suitable ?lm to identify small
pneumothoraces.
Tension Pneumothorax
In tension pneumothorax, air leaks into the pleuralcavity with no escape route o
n account of a one-way valve effect. It is a life-threatening conditionbecause o
f the severe cardiorespiratory failure thatensues. The patient is panicky and ha
s dyspnea,cyanosis, shock, and distended neck veins. Thetrachea is shifted to th
e opposite side, there are
C
Figure 4.5 (
cont
.)
4.3 Hemo-Pneumothorax 81
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no breath sounds and there is hyperresonance onpercussion in the affected hemith
orax. Immediatelife-saving therapy is needle decompression of the chest, followe
d by formal thoracostomy tubeinsertion. The mere suspicion of a tension pneumo-t
horax is an absolute indication for a needledecompression whenever a thoracostom
y tubecannot be inserted immediately (prehospital stage,

ABC
Figure 4.7 Tension pneumothorax. (A) Illustrationshowing mechanism of tension pn
eumothorax.Extrapulmonary air under tension collapses the lung,depresses the dia
phragm, and pushes the heart towardthe opposite side. The normal lung is compres
sed in thecontralateral pleural cavity. These changes causecardiorespiratory fai
lure. (B) Chest x-rays showing a largetension pneumothorax on the left side, med
iastinal shiftto the opposite side, and downward displacement of theleft hemidia
phragm. Arrows point to tensionpneumothorax. (C) Tension pneumothorax on the CTs
can (arrow). Note the deviation of the heart to the right.
AB
Figure 4.6 Pneumothorax. (A) Large right pneumothorax on chest x-ray. Arrow poin
ts to collapsed lung. (B) Bilateralpneumothoraces on CT scan (arrows).
82 Thoracic Injury
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EVENIMENT
GALERIE FOTO Trei raniti, printre care si un copil, la spital dupa ce un sofer n
u a acordat prioritate
Trei raniti, printre care si un copil, la spital dupa ce un sofer nu a acordat p
rioritate
Accident de circula?ie, duminica dupa-amiaza, n centrul localita?ii timi?ene Chi?
oda. Trei persoane, printre care ?i un copil, au ajuns la spital dupa ce ma?inil
e n care se aflau s-au ciocnit violent din cauza unui ?ofer care nu a acordat pri
oritate.
Trei raniti, printre care si un copil, la spital dupa ce un sofer nu a acordat p
rioritate
ROMNIA
STIRE DE ULTIMA ORA Dacian Ciolos si-a ales guvernul
Dacian Ciolos si-a ales guvernul
Premierul desemnat, Dacian Ciolo?, ?i-a prezentat duminica dupa-amiaza, la Parla
ment, guvernul. Luni ?i mar?i ar urma audierile mini?trilor propu?i n comisiile d
e specialitate din Parlament, apoi votul de investitura n plenul reunit al Camere
i Deputa?ilor ?i Senatului. Lista mini?trilor.
ADMINISTRATIE
GALERIE FOTO Sensul giratoriu de la stadion e gata, dar nu poate fi folosit. Pro
bleme pe santierul Podeanu
Sensul giratoriu de la stadion e gata, dar nu poate fi folosit. Probleme pe sant
ierul Podeanu
Sunt probleme pe nca un ?antier din Timi?oara. De?i ar fi trebuit sa fie gata nca
din luna septembrie, strada Podeanu nu va fi deschisa circula?iei prea curnd. Nou
l sens giratoriu de la stadion, inclus n proiect, este amenajat, dar nu va putea
fi folosit pna cnd nu va fi nchis ?antierul de pe Podeanu. 2
Probleme pe santierul de pe PodeanuProbleme pe santierul de pe Podeanu II
LOCAL
Societatea lui Titu Bojin a vandut catre Dedeman un teren pentru 1,2 milioane de
euro
Societatea lui Titu Bojin a vandut catre Dedeman un teren pentru 1,2 milioane de
euro
Compania Dedeman, specializata n domeniul magazinelor de bricolaj, pare sa fie ex
trem de multumita de cum merg afacerile n Banat. Societatea a anuntat ca a batut
palma cu cei de la Lugomet, pentru a prelua o parte din terenul fabricii, pentru
a deschide o unitate ?i la Lugoj. Marele beneficiar al tranzactiei de 1,2 milio
ane de euro ar urma sa fie Titu Bojin, seful Consiliului Judetean Timis, princip
alul actionar al companiei lugojene. O alta parte din teren va ajunge la produca
torul de ncaltaminte Rieker. 1
INVATAMANT
Rezidentiat 2015: viitorii medici, in examen la Timisoara
Rezidentiat 2015: viitorii medici, in examen la Timisoara
Emotii pentru viitoarea genera?ie de medici la Timisoara. Duminica, acestia s-au
aflat n fata unuia dintre cele mai importante examene din viata lor: Rezidentiat
ul. Candidatii au trebuit sa raspunda unui test grila cu 200 de ntrebari.

ANUNTURIOpel Astra
Opel Astra
Vw Golf
Vw Golf
Opel Vectra
Opel Vectra
MAPAMOND
Atacurile teroriste de la Paris: sase complici au fost arestati in Franta
Atacurile teroriste de la Paris: sase complici au fost arestati in Franta
Autoritatile franceze au arestat preventiv sase persoane din anturajul teroristu
lui kamikaze Omar Ismail Mostefai, care a fost identificat drept unul dintre aut
orii atentatelor de la Paris. Premierul francez a declarat ca Fran?a este n razbo
i ?i va distruge re?eaua terorista Stat Islamic.
EVENIMENT
GALERIE FOTO Accident la iesire din Timisoara: un sofer beat a ajuns cu masina i
ntr-un sens giratoriu
Accident la iesire din Timisoara: un sofer beat a ajuns cu masina intr-un sens g
iratoriu
Diminea?a cu ghinion pentru un timi?orean de 31 de ani care a decis sa se urce l
a volan, de?i nainte consumase mai multe pahare cu vin. Acesta se ndrepta spre Tim
i?oara, cnd la intrare n ora?, pe Calea Aradului, nu a mai vazut sensul giratoriu
?i a intrat direct n el. 2
Accident la iesire din Timisoara
LOCAL
VIDEO Peripetiile unei calatorii cu tramvaiul Armonia, prin camera video a unei
timisorence
Peripetiile unei calatorii cu tramvaiul Armonia, prin camera video a unei timiso
rence
Tramvaiele modernizate ale Timi?oarei circula deja de ceva vreme pe liniile RATT
. Peste 500.000 de euro a costat recondi?ionarea unui tramvai, iar calatorii au
remarcat deja probleme. 7
SANATATE
Sectie noua la Maternitatea Bega - Terapie Intensiva Pediatrica
Sectie noua la Maternitatea Bega - Terapie Intensiva Pediatrica
Clinica de Obstetrica Ginecologie Bega (Maternitatea Bega) din Timisoara nu a avut
pna acum o sectie de Anestezie si Terapie Intensiva (ATI) destinata celor mici.
Dar, acum s-au alocat fonduri pentru ca aceasta sectie sa fie dotata cu aparatur
a necesara acestui compartiment din Maternitatea Bega, care tine de Spitalul Jud
etean Timisoara.
POLITIC
PNL Timis vrea alegeri anticipate: parlamentarii sa-si dea demisia in bloc
PNL Timis vrea alegeri anticipate: parlamentarii sa-si dea demisia in bloc
Conducerea PNL Timi? considera ca na?ional liberalii au o ?ansa reala la alegeri
le de anul viitor. Unul dintre liderii filialei este de parere ca un guvern de t
ehnocra?i nu trebuie sa fie unul de cursa lunga, iar parlamentarii ar trebui sa?i dea demisia n bloc ?i sa fie organizate alegeri anticipate. 6
ANUNTURI
yorkshire mini toy
yorkshire mini toy
Samsung Note 4
Samsung Note 4
Vand bratara barbati aur 14 K
Vand bratara barbati aur 14 K
LOCAL
Soarta comunitatilor maghiare dispersate, dezbatuta la Timisoara
Soarta comunitatilor maghiare dispersate, dezbatuta la Timisoara
La Timisoara se desfasoara duminica, 15 noiembrie, Ziua Diasporei Maghiare. Nu m

ai putin de 55 de delegati din noua judete se afla n urbea de pe Bega pentru a de


zbate soarta acestor comunitati dispersate. Momentul principal este adoptarea pl
anului de actiune
practic se decide care sunt principalele actiuni care trebuie
desfasurate pentru mentinerea acestor comunitati dispersate.
EVENIMENT
GALERIE FOTO Accident mortal aproape de Moravita. Doi oameni au murit
Accident mortal aproape de Moravita. Doi oameni au murit
Accident grav de circula?ie, pe drumul care leaga Moravi?a de localitatea Oravi?
a, smbata dupa-amiaza. Doi barba?i ?i-au pierdut via?a, dupa ce ma?ina n care se a
flau s-a izbit violent de un autobuz plin cu muncitori.
UPDATE. Un cititor Tion.ro a fost martor la accident ?i ne-a trimis imagini de l
a locul impactului. 1
Accident mortal aproape de Moravita
TURISM
Cele mai vechi locuri din lume: top 10 destinatii antice care au marcat omenirea
Cele mai vechi locuri din lume: top 10 destinatii antice care au marcat omenirea
Cei fascina?i de istorie nu ar trebui sa rateze o excursie ntr-una dintre aceste
locuri incredibile, care debordeaza de istorie ?i legende. Nimic nu se compara c
u o plimbare printre ruinele locurilor unde au luat na?tere primele civilizatii
ale lumii.
PARTY
GALERIE FOTO Timisoara, alaturi de victimele din Colectiv! #ImpreunaRezistam a s
trans zeci de mii de lei
Timisoara, alaturi de victimele din Colectiv! #ImpreunaRezistam a strans zeci de
mii de lei
#mpreunaRezistam! Acesta a fost mesajul transmis de 16 trupe timi?orene, care au
urcat pe scena pentru a sus?ine victimele tragicului accident din Colectiv. De?i
vremea nu a fost tocmai prietenoasa, cteva sute de timi?oreni au ie?it din case
?i au donat sume substan?iale pentru cei care au fost afecta?i de incendiul din
clubul bucure?tean.
#ImpreunaRezistam a strans zeci de mii de lei din donatii
MAPAMOND
Microbuz inmatriculat in Romania, rasturnat in Ungaria: soferul a murit si noua
pasageri, raniti
Microbuz inmatriculat in Romania, rasturnat in Ungaria: soferul a murit si noua
pasageri, raniti
Un microbuz nmatriculat n Romnia s-a rasturnat dupa ce a lovit un autoturism n sud-e
stul Ungariei. n urma impactului, ?oferul microbuzului, o femeie, a murit, iar n
oua pasageri au fost rani?i.
ANUNTURIProprietar, vand apartament 3 camere din 4, Dacia
Proprietar, vand apartament 3 camere din 4, Dacia
Casa cu garaj si teren 2000mp
Casa cu garaj si teren 2000mp
Vila deosebita
Vila deosebita
Fara apa si caldura, luni, pe doua strazi din Timisoara
UTILE
Fara apa si caldura, luni, pe doua strazi din Timisoara
Colterm ?i Aquatim i lasa pe timi?oreni fara apa ?i caldura, luni, pe doua strazi
importante din ora?. Societatea de termoficare opre?te ncalzirea din cauza unei
defec?iuni, iar cea de apa ?i canal din pricina unor lucrari.
LOCAL
GALERIE FOTO Mii de voluntari au plantat fapte bune. Aproape 38.000 de puieti sa
diti langa Timisoara
Mii de voluntari au plantat fapte bune. Aproape 38.000 de puieti saditi langa Ti
misoara
Timi?enii au profitat de vremea frumoasa de smbata ?i au ie?it sa planteze fapte b
une. S-a ntmplat la Utvin, unde ?i-au dat ntlnire aproximativ 3.000 de voluntari. Au
reu?it sa sadeasca aproape 38.000 de puie?i. 1

Aproape 38.000 de puieti saditi langa Timisoara


SPORT LOCAL
Ripensia Timisoara ajunge pe primul loc in campionat, dupa ce Masloc ia bataie l
a Ghiroda
Ripensia Timisoara ajunge pe primul loc in campionat, dupa ce Masloc ia bataie l
a Ghiroda
Ripensia Timisoara a beneficiat din plin de victoria Ghirodei mpotriva celor de l
a Masloc. Dupa ce a nvins la Snnicolau Mare, iar fostul lider a luat bataie de la
echipa lui Paul Codrea, Ripi a trecut n frunte. 1
SPORT LOCAL
Mai buni, dar nu suficient. Dinamo Bucuresti
BC Timisoara: 88 - 78
Mai buni, dar nu suficient. Dinamo Bucuresti BC Timisoara: 88 - 78
Schimbarile efectuate n activitatea BC Timisoara se vad deja n jocul prestat, dar
la echipa mai este de lucrat. Aceasta poate fi concluzia si n urma meciului susti
nut mpotriva celor de la Dinamo Bucuresti, n deplasare. Echipa banateana a dat sem
ne ca poate nvinge, dar finalul dezastruos si-a spus cuvntul si echipa a pierdut,
cu 78
88.
MAPAMOND
GALERIE FOTO Bilantul terorii de la Paris: cel putin 120 de morti in mai multe a
tacuri teroriste
Bilantul terorii de la Paris: cel putin 120 de morti in mai multe atacuri terori
ste
Cel pu?in 120 de persoane au murit ?i alte cteva sute au fost ranite, dintre care
99 sunt n stare grava, vineri seara, n centrul Parisului, dupa ce indivizi narma?i
au deschis focul n mai multe locuri din capitala Fran?ei. Pre?edintele francez,
Francois Hollande, a decretat stare de urgen?a ?i a chemat armata. Strazile sunt
pustii n Paris.
UPDATE. Reteaua terorista Stat Islamic a revendicat atentatele de la Paris.
UPDATE 2. Un alt ceta?ean romn a fost ranit n atacurile teroriste de vineri seara.
UPDATE 3. Doi romni au murit n atacurile de la Paris.
UPDATE 4. Autoritatile franceze urmaresc mai multe masini cu care ar fi reusit s
a fuga unii dintre atacatori.
UPDATE 5.
de France
UPDATE 6.
rsoane au

Pa?aportul gasit printre rama?i?ele atacatorilor kamikaze de la Stade


apar?ine unui migrant sirian nregistrat n Grecia.
Bilantul victimelor a ajuns la 129 de morti si 352 de raniti. Patru pe
fost arestate n Bruxelles n acest caz

34
Bilantul terorii de la Paris: cel putin 120 de morti in mai multe atacuri terori
ste
MAPAMOND
Cel putin cinci persoane au murit dupa ce un tren a deraiat in Franta
Cel putin cinci persoane au murit dupa ce un tren a deraiat in Franta
nca un incident ?ocant n Fran?a. Cel pu?in cinci persoane au murit, smbata dupa-ami
aza, dupa ce un tren a deraiat n nordul ora?ul francez Strasbourg.
LOCAL
GALERIE FOTO Mitropolitul Banatului si-a celebrat ziua de nastere cu nevoiasii,
la cantina din Iosefin
Mitropolitul Banatului si-a celebrat ziua de nastere cu nevoiasii, la cantina di
n Iosefin
Mitropolitul Banatului PSS Ioan si-a aniversat ziua de nastere alaturi de saracii
Timi?oarei, la cantina sociala din Parohia Iosefin, care a fost inaugurata smbat
a, dupa ce a trecut prin mai multe renovari. 2
Mitropolitul Banatului si-a celebrat ziua de nastere cu nevoiasii, la cantina di
n Iosefin
ADMINISTRATIE
Mii de timisoreni pusi pe drumuri pentru taxa de poluare. Robu: vina este a Dire
ctiei Fiscale

Mii de timisoreni pusi pe drumuri pentru taxa de poluare. Robu: vina este a Dire
ctiei Fiscale
Nu mai pu?in de 8.000 de timi?oreni au primit soma?ii de la Direc?ia Fiscala, fi
ind chema?i la sediul institu?iei sa achite taxa de poluare, de?i au firme cu ac
tivita?i care nu produc impact asupra mediului. Cum pot scapa de plata taxei? 8
Vrei sa iti scoti copilul minor din tara? Iti trebuie cazier judiciar
LOCAL
Vrei sa iti scoti copilul minor din tara? Iti trebuie cazier judiciar
Daca inten?iona?i sa pleca?i n vacan?a n strainatate alaturi de minori, Poli?ia Ro
mna anun?a ca pe lnga celelalte documente prevazute de lege, persoana care i nso?e?t
e pe copii trebuie sa aiba la ea certificatul de cazier judiciar. 3
LOCAL
Atentionare meteo: doua zile de vant puternic in Banat
Atentionare meteo: doua zile de vant puternic in Banat
Meteorologii au transmis, smbata, o aten?ionare de vnt puternic valabila pentru ac
est sfr?it de saptamna n mai multe regiuni ale ?arii, inclusiv Banat. Astfel, vntul
va atinge, la rafala, viteze de pna la 60 km/h.
LOCAL
Mitropolitul Banatului despre atentatele de la Paris: Inima Frantei a sangerat
Mitropolitul Banatului despre atentatele de la Paris: Inima Frantei a sangerat
ntreaga lume a fost socata n urma tragediei petrecute n capitala Frantei, vineri se
ara. Cel pu?in 120 de persoane au murit ?i alte cteva sute au fost ranite, dintre
care 99 sunt n stare grava, n urma atentatelor. Mitropolitul Banatului PS Ioan a u
rmarit evenimentele petrecute n capitala Frantei si a ramas nmarmurit n fata aceste
i tragedii. 3
LOCAL
Timisoara intra in #Colectiv la concertul #ImpreunaRezistam
Timisoara intra in #Colectiv la concertul #ImpreunaRezistam
Smbata, ntreaga Romnie va comemora, prin muzica, victimele tragicului accident din
Colectiv. Concertul #mpreunaRezistam va avea loc, simultan, n diferite ora?e din ?
ara. Desigur, Timi?oara se numara printre ele, iar to?i banii ob?inu?i de pe urm
a evenimentului vor ajunge la victimele incendiului din capitala. Publicul va pu
tea sa faca ?i dona?ii. 1
ADMINISTRATIE
GALERIE FOTO Inaugurare marca primarie: Robu merge cu troleibuzul la Dumbravita,
calatorii inca nu
Inaugurare marca primarie: Robu merge cu troleibuzul la Dumbravita, calatorii in
ca nu
A fost nchis n sfr?it ?antierul de pe Calea Lipovei. De?i troleibuzul 14 ar fi treb
uit sa circule pna la Dumbravi?a nca de la nceputul saptamnii, acest lucru nu se va n
tmpla prea curnd. RATT nu a terminat de implementat proiectul pe fonduri europene.
27
Robu merge cu troleibuzul la Dumbravita, calatorii inca nu
ROMNIA
Doi cetateni romani au murit la Paris in urma atacurilor teroriste
Doi cetateni romani au murit la Paris in urma atacurilor teroriste
Ministerul Afacerilor Externe anun?a ca doi ceta?eni romni ?i-au pierdut via?a n u
rma atacurilor de vineri de la Paris.
Bilantul terorii de la ParisExplozii si atacuri la Paris
SPORT LOCAL
ASU Politehnica Timisoara isi consolideaza prima pozitie in clasamentul Ligii 3
ASU Politehnica Timisoara isi consolideaza prima pozitie in clasamentul Ligii 3
Alb-violetii de la ASU Politehnica Timisoara si-au consolidat prima pozitie din
clasamentul seriei a patra a Ligii 3, dupa ce au nvins n deplasare echipa celor de
la Cetate Deva.
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17C
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Cum va fi vremea, mar?i, 17. noiembrie 2015: 18 C (Timisoara)
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Bilantul terorii de la Paris: cel putin 120 de morti in mai multe atacuri teror
iste 34
Inaugurare marca Primaria Timisoara: Robu merge cu troleibuzul la Dumbravita, c
alatorii inca nu 27
Vaporase ca in Amsterdam, la Timisoara. Stim cand vine prima ambarcatiune 17
ULTIMELE STIRI
14:55 Trei raniti, printre care si un copil, la ...
13:51 Rezidentiat 2015: viitorii medici, in examen ...
12:59 Numarul ungurilor din Timis e in scadere. ...
12:44 Fara apa si caldura, luni, pe doua strazi din ...
12:28 Sensul giratoriu de la stadion e aproape ...
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TionTV: Tanar ucis de un elev la cativa pasi de o scoala din Timisoara
TionTV: Tanar ucis de un elev la cativa pasi de o scoala din Timisoara
TionTV: Criminalii din Complexul Studentesc, dusi la reconstituire
TionTV: Criminalii din Complexul Studentesc, dusi la reconstituire
TionTV: Detalii socante in dosarul crimei din Complexul Studentesc
TionTV: Detalii socante in dosarul crimei din Complexul Studentesc

Protest in Piata Operei din Timisoara: mii de timisoreni, alaturi de manifestant


ii din Bucuresti
Protest in Piata Operei din Timisoara: mii de timisoreni, alaturi de manifestant
ii din Bucuresti
TionTV: Circulatia tramvaielor, blocata de un bizon care a trecut pe rosu
TionTV: Circulatia tramvaielor, blocata de un bizon care a trecut pe rosu
TionTV: Incendiu in trafic, la Timisoara
TionTV: Incendiu in trafic, la Timisoara
Party in Timis
Timisoara, alaturi de victimele de la Colectiv! #ImpreunaRezistam a strans zeci
de mii de lei din donatii
Timisoara, alaturi de victimele de la Colectiv! #ImpreunaRezistam a strans zeci
de mii de lei din donatii
#ImpreunaRezistam a strans zeci de mii de lei din donatii
Revolutia Muzicala de la Timisoara s-a anulat! Nu s-a gasit nicio locatie pentru
eveniment
Revolutia Muzicala de la Timisoara s-a anulat! Nu s-a gasit nicio locatie pentru
eveniment
Un club din Complexul Studentesc isi suspenda activitatea. Conducerea spune ca d
e vina e primaria
Un club din Complexul Studentesc isi suspenda activitatea. Conducerea spune ca d
e vina e primaria
LOCAL
Bicicleta furata din bloc, in timpul zilei
Alta bicicleta furata din bloc la Timisoara. Furtul a avut loc n timpul zilei, nu
la adapostul ntunericului. Campania Ti s-a furat bicicleta, TION te ajuta sa o ga
sesti! vrea sa faca lumina n acest caz si n alte situatii n care bicicletele le-au f
ost rapite proprietarilor.
LOCAL
Bicicleta furata din fata blocului in interval de 20 de minute
O alta bicicleta s-a furat la Timisoara. Este vorba despre o bicicleta furata de
pe bulevardul Corneliu Coposu din Timisoara, chiar din fata blocului. Campania T
i s-a furat bicicleta, TION te ajuta sa o gasesti! continua!
LOCAL
Bicicleta furata din scara blocului, din cartierul Freidorf
Furturile de biciclete din Timisoara continua. Ca si n alte cazuri, s-a furat din
nou o bicicleta din scara blocului. Campania Ti s-a furat bicicleta, TION te aju
ta sa o gasesti! continua.
LOCAL
Trei biciclete furate din Timisoara. Unul dintre pagubiti i-a vazut pe posibilii
suspecti
Alte trei biciclete au fost furate din Timisoara n ultima perioada. Pagubitii vor
sa si le recupereze. Ajutati-i n acest demers! Campania Ti s-a furat bicicleta, T
ION te ajuta sa o gasesti! continua.
LOCAL
Bicicleta furata de la... etajul trei, la Timisoara
O alta bicicleta a fost furata la Timisoara. n aceasta perioada se pare ca hotii
actioneaza n interior. Si aceasta bicicleta, la fel ca si altele, a fost furata di
n casa scarii. Campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti! contin
ua.
LOCAL
Bicicleta furata din scara blocului, la Timisoara
Vremea din ce n ce mai rece face ca biciclistii sa mai lase vehiculele cu doua ro
ti acasa. Oricum, unii dintre ei le mai folosesc. Daca le au, pentru ca unii au

ramas fara ele n urma actiunilor neobositilor hoti de biciclete din Timisoara. In
diferent de anotimp, campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti!
continua!
LOCAL
Bicicleta furata de sub fereastra apartamentului, la Timisoara
Hotii de biciclete actioneaza asiduu n aceste zile la Timisoara. Unui locuitor al
urbei de pe Bega i-a fost furata bicicleta chiar de sub geam. Campania Ti s-a fu
rat bicicleta, TION te ajuta sa o gasesti! continua.
LOCAL
Bicicleta furata in urma cu un an, reperata in trafic. Proprietarul ofera recomp
ensa
La un an dupa ce bicicleta i-a fost furata, a vazut-o din nou, n trafic. Acum, pa
gubitul are din nou sperante ca o va regasi, mai ales ca nu sunt multe astfel de
modele n oras. Campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti! pune u
marul, mpreuna cu dumneavoastra, la depistarea vehiculului cu doua roti care a fo
st furat de lnga proprietar n urma cu un an.
LOCAL
Hoti inventivi la Timisoara - bicicleta furata cu lemnul
O bicicleta a fost furata din zona Printul Turcesc din Timisoara. Hotii au dat d
ovada de inventivitate n cazul acestui furt. Campania Ti s-a furat bicicleta, TION
te ajuta sa o gasesti! continua.
LOCAL
Bicicleta furata de la etajul IV, dintr-un bloc din Timisoara. Pagubitul crede c
a s-a actionat la pont
Furtul de biciclete ia amploare n Timisoara. Acum, cnd vara este aproape de sfrsit,
hotii dau spargeri dupa spargeri si fura vehiculele cu doua roti. Campania Ti sa furat bicicleta, TION te ajuta sa o gasesti! continua!
LOCAL
Hotii au tras cortina peste mersul pe doua roti. Un actor a ramas fara bicicleta
la Timisoara
Hotii actioneaza n continuare n forta n Timisoara, atunci cnd vine vorba de biciclet
e. Recent au furat bicicleta unui actor care colaboreaza cu Teatrul National Tim
isoara. Campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti! continua.
LOCAL
Alte doua biciclete au picat pe mana hotilor, la Timisoara
Hotii de biciclete din Timisoara parca nu mai au astmpar, n ultimul timp. Nu numai
ca fura biciclete, dar reusesc sa faca acest lucru ntr-un timp record. Campania T
i s-a furat bicicleta, TION te ajuta sa o gasesti! continua.
LOCAL
Bicicleta furata din centrul Timisoarei de doi tineri in slapi, chiar sub camere
le de filmat
O alta bicicleta a fost furata n Timisoara. De data aceasta chiar din centrul urb
ei de pe Bega. Campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti! contin
ua.
LOCAL
Bicicleta furata din uscatoria blocului. Ajutati-l sa o gaseasca!
O alta bicicleta s-a furat la Timi?oara. De data aceasta din uscatoria blocului,
din zona Calea ?agului. Campania ?i s-a furat bicicleta, TION te ajuta sa o gase
?ti! continua.
LOCAL
Doua biciclete furate dintr-un foc, dintr-o uscatorie din Timisoara, zona Mircea

cel Batran
Hotii au furat doua biciclete dintr-un foc, la Timisoara, din uscatoria unui blo
c. Campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti! continua.
LOCAL
Bicicleta furata din scara blocului. Ajutati-l sa o gaseasca!
O alta bicicleta a fost furata la Timisoara, de data aceasta din scara blocului.
Campania Ti s-a furat bicicleta, TION te ajuta sa o gasesti! continua.
LOCAL
Bicicleta furata din Complexul Studentesc
Hotii de biciclete din Timisoara nu se lasa. Chiar si n aceste zile ploioase, cnd
nu-ti vine sa scoti afara niciun cine, hotii actioneaza si dau iama n bicicletele lo
cuitorilor urbei de pe Bega. Nici campania Ti s-a furat bicicleta, TION te ajuta
sa o gasesti! nu se lasa! Continua!
LOCAL
Inca o bicicleta furata in zona Lunei
O alta bicicleta a fost furata din Timisoara. De data aceasta, hotii au actionat
n zona Lunei, pe nserat. Campania Ti s-a furat bicicleta, TION te ajuta sa o gases
ti! continua.
LOCAL
Bicicleta furata din centrul Timisoarei. Se ofera recompensa!
O alta bicicleta a fost furata zilele trecute chiar din centrul Timisoarei. Camp
ania `Ti s-a furat bicicleta, TION te ajuta sa o gasesti! continua!
LOCAL
O alta bicicleta furata din Timisoara, chiar din rastel
Furtul de biciclete n Timisoara continua, pe masura ce oamenii pleaca n concediu,
iar hotii deja s-au saturat de soare. Continua si campania Ti s-a furat bicicleta
, TION te ajuta sa o gasesti .
LOCAL
Hotii de biciclete nu-si iau concediu! Doua biciclete furate in ultimele zile di
n Timisoara!
Hotii de biciclete nu si-au luat concediu la Timisoara. Continua sa actioneze si
sa fure bicicletele de peste tot. Nici campania
Ti s-a furat bicicleta, TION te a
juta sa o gasesti! nu intra n concediu! Continua!
LOCAL
Ajutati-l pe Ciprian sa isi recupereze bicicleta furata
Aproape ca nu e zi n care sa nu fie furata o bicicleta, la Timisoara. Desi multe
dintre ele sunt scoase la vnzare de hoti, foarte putine sunt recuperate de propri
etare. De aceea, tion.ro continua campania Ti s-a furat bicicleta? Tion te ajuta
sa o recuperezi . Astazi va rugam sa ne ajutati sa recuperam bicicleta lui Ciprian
.
LOCAL
Bicicleta furata, prezentata in cadrul campaniei Tion, recuperata de proprietar
Dupa ce n ultimele doua zile v-am prezentat cazul lui Lucian, tnarul care si-a rec
uperat bicicleta furata din zona Punctelor Cardinale din Timisoara datorita vigi
lentei unui timisorean, iata ca suntem n masura sa va prezentam un nou caz cu fin
al fericit. O bicicleta furata n urma cu aproape un an, prezentata n cadrul campan
iei Ti s-a furat bicicleta? Tion te ajuta sa o recuperezi! a ajuns napoi la proprie
tar.
LOCAL
Bicicleta furata, recuperata de un timisorean cu un excelent simt al observatiei
O excelenta poveste ne-a fost trimisa, marti seara, pe adresa redactiei de un ci

titor tion.ro care a reusit, printr-un simt al observatiei si o prezenta de spir


it excelente, sa recupereze o minunata bicicleta alba, la cteva momente dupa ce a
fost furata, n zona Punctele Cardinale din Timisoara. Cum oamenii legii nu i-au
lasat prea multe optiuni, omul a apelat la ajutorul nostru pentru a-l gasi pe ad
evaratul proprietar, care, cu siguranta, la ora aceasta i duce dorul.
LOCAL
Bicicleta furata de la mall-ul din Timisoara
n ultimul timp, hotii actioneaza din ce n ce mai des. Ace?tia au reu?it sa fure o
alta bicicleta, la Timisoara. Campania Ti s-a furat bicicleta, TION te ajuta sa o
gasesti! continua.
publi tim online
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