Dy 7 ,; / Rofataccuffinjury, damage to the glenoid labrum and detachment of the antero- inferior segment called Bankart and Hill sacks lesion, ion: be reduced as early as possible, There are three methods of itsRADIOLOGY An 8 years old boy falls movements of the ar re shown in figure 14. Carefully with: swol elbow, his 1 in the whole limb. His radiograph is gtaph and answe tions. lowing gu 1. What is the diagnos 2, Which nerve is most commonly injur ed in this type of fracture? 3. What are the other complications of this fracture? 4, How will you manage this patient? Answers: ac 5 Supracondylar fracture of the humerus (Type III) 2. Median nerve, Civicq) - = Ya. Vascular injuries: Brachial artery, %b. Nerves—radial, ulnar, median. is reduced under anesthesia by needed if closed reduction fails by k-wires,Figure 16 This.1s the radiograph of 55 years old woman who has fallen on an outstretched hand in bathroam.On exarnination| she has dinner fork deformity of the hand:Carefully observe this radiograph (figure 16) and answer thi What are the findings on this radiograph? What this fracture is called? What do you mean by dinner fork deformity? What are the complications of this fracture? What is the management of this fracture? ie questions, 1 2 = 3 4, 5. Answers: 1. Fracture of the distal end of the radius 2) Colles’ Fracture: Colles’ fracture is the fracture of radius ‘within.2.S¢m_of wrist joint and there is dorsal displacement of the distal segment. 3. In this fracture the distal segment of radius is displaced dorsally and radially and wrist looks like a dinner fork (figure 17) (2 = : © Median nerve injury a © Malunion 2 . icis longus tendor Sa Rupture of extensor pollicis longus tendon = Se S alg . Sudeck’s atrophy Joint stiffness Figure 17 af e methods. Close reduction is ‘ive treatment is rarely needed,RADIOLOGY Amotoreyclist was involved in roadside accident. He fs unable to move his lawerlimbs, His Rays are shown in figure 10, Carefully examine this Xray and answer the questions given below: ed? Hf this patient? anterior vertebral awing vertebral lines. The tar line as shown figure 127.) praacs and" — Figure 11 The anterior vertebral line, posterior vertebral line and spinolaminar line should have a smooth curve with no steeps or discontinuities. Note that malalignment of the posterior vertebral bodies is' more significant than that of anterior because of its proximity to the spinal cord. A translocation of > 3.5mm is significant anywhere. Spinal canal diameter (between posterior cortex of vertebral Bodies and spinolaminar line) should be 18mm or greater. Narrowing of the canal is definitely present if this is reduced to 14mm or less. 3. Follow the ATLS guidelines, cervical spine control by applying cervical collar, sand bags and forehead tapes. i 4. Pars es v * v ia, loss of bowel and bladder control, paralysis of breathing muscles etc, CES = bhvete neveyears old boy sustained injury to his arm while playing and he has deve Carefully observe the X-ray (figure 13) of this patient and answer the following questior 1, What is the diagnosis? 2. Name two treatment options. 3. What complications can occur? Answers: 1, Fracture of shaft of humerus,OSPE/OSCE/TOACS and Clinical Methoos #1 Stary wren 1 ) Carefully observe the provided radiological study (figure 15) and answer the following questions Namie this investigation. What are the positive findings? 1 2 3. What type of fracture is this? 4, What are the emergency management steps of this patient? 5. What is definite management of this fracture? Answers 1. Radiograph of the radius and ulna; AP (anteroposterior) and lateral view 2. Fracture of the radius and ulna. te (BCP) for radius and ulna. heakricall ¢- G Figure 23 35 years old labourer fell from the hight and he has a wound of about 10 x 8 cm in size over the middle of right shin leading to exposed bone: X-rays shown in figure 23 1, Whats the possible injury to this leg? 2. Whatare the associate injuries with this fracture? 3. What is the most appropriate treatment? 4, What are the complications of this injury shown? Answers: 1. Open fracture tibia and fibula, 2. Axil injuries to spine, hip, distal tibia and calcaneus and chest injuries. 3. Follow ATLS guide lines, Antibiotics, Analgesia, Tetanus prophylaxis, meticuolous debridement of this wound, fracture site curettage and external fixation, & Neuro vascular injury, infection, non union, associated abdominal and chest injuries. step Heed————— — RADI Figure 21 igure 2 25 years old male suffered from road side accident. Sustained injury to his left hip causing painful hip joint, shortened left leg and externally rotated foot. He is unable to walk and can’ t even bear weight over his left leg 1. What is the diagnosis on x-ray (figure 21)? 2. What is the most appropriate treatment of this injury? 3. What are the most common complications? AnswersiAPractical G ide to This 10 yeats old boy (figure 18, 19} was brought to the emergency depertmen after a fall from height. His right leg seems to be shiorténed, Intéihally rotated and flexed. His shown in figure 18. Read this x-ray carefully and answer the following questions ray pelvis is 1. What are the findings.on this x-ray? 2. What is most common neurological injury associated with th 3. Give treatment options to manage this injury? ma? Answers: 1 Posterior dislocation of right hip joint. 2 Sciatic nerve injury. 3 a. Follow ATLS protocals b. Close reduction byCTractin & NMenipule! i. Allis’s Maneuver of reduction. pee ii, Stimson’s Gravity Method.= Fig 2D years old boy suffered an injury to his right lower limb after motor cycle accident causing painful limb with swelling of right thigh and leg. His X-rays is shown In figure 22 1, Whatis the diagnosis? 2. What are the complications associated with these injuries? 3. What are the treatment options? Answers: 1. Fracture of shaft of femur along with fracture proximal tibia and fibula (floating knee injuries). r Popliteal ment syndrome, fat embolism. AS °F n emur (intramedullary: nail) and