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UNIT 5 TRAUMA AND ORTHOPAEDICS

A WHY TRAUMA AND ORTHOPAEDICS

1 Trauma and orthopaedic surgeons diagnose and treat a wide range of conditions of the
musculoskeletal system. This includes bones and joints and their associated structures that
enable movement – ligaments, tendons, muscles and nerves. Trauma and orthopaedic
surgery is often abbreviated to T&O surgery.4

Why do you think some physicians find this field attractive and choose it as their specialty?

2 You are going to read a career story of Dr Edward Gee, a specialty registrar in T&O. 5 With your partner,
discuss the meaning of the following expressions and match them with their definitions.

camaraderie placement repositioning emergency trauma


straighten undertake rounds registrar entrapment
portfolio competent references efficient

1 a regular tour of inspection in which the well-being of those visited is checked


_________________
2 (as modifier) arising from a serious and/or dangerous situation requiring immediate action
_________________
3 to commit to and begin sth, take on
_________________
4 to extend or move in one direction only, without a curve or bend
_________________
5 mutual trust and friendship among people who spend a lot of time together
_________________
6 to adjust or alter the way sb or sth is placed or arranged
_________________
7 temporary posting of someone in a workplace to enable them to gain work experience
_________________
8 physical injury
_________________
9 a middle-ranking hospital doctor undergoing training as a specialist
_________________
10 the state of being caught in or as in a trap
_________________
11 a set of documents intended to demonstrate a person's ability to a potential employer
_________________
12 working in a well-organized and competent way
_________________
13 having the necessary ability, knowledge, or skill to do something successfully
_________________
14 people who agree to testify to someone’s ability or reliability when they apply for a new job, another
word is a referee
_________________

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UNIT 5 TRAUMA AND ORTHOPAEDICS

3 Now use the words from the previous exercise in their correct form to complete the gaps in the text below.

What I do injection, whereas other operations, to stabilise someone’s


Higher specialist training in T&O surgery takes six years and neck or 7 _______________ a spine, may take up to five
involves six-month 1 _______________ in the different sub- hours. I also see patients before and after surgery on my
specialty areas. I’m currently working as a spinal regular ward 8 _______________.
2 _______________ and see patients with degenerative I spend one day a week 9 _______________ research. I fit in
spinal conditions, spinal cord compression, nerve my admin during lunch breaks or at the end of the day. I also
3 _______________, and those who have injured their teach medical students and junior doctors.
backs.
The best bits and challenges
I normally have three half-day clinics each week – two spinal
clinics and one fracture clinic. At the fracture clinic I see I love T&O surgery, as you often have the opportunity to
around 30 patients (children and adults) with broken bones immediately improve someone’s life, whether you are fixing
and making decisions this quickly is challenging. Most need a broken bone or replacing a knee or hip. Working as part of
their fracture setting in a friendly team is fantastic and my specialty has a great
plaster by the technician, 10 _______________.
but some fractures Along with managing my time effectively, another challenge
require is moving around the different sub-specialties, as you have
4 _______________ or to become 11 _______________ in a new area quickly. I
surgery. make time for reading whenever possible, as there is so
I am on-call for 24 hours much to learn. My working day can be as long as 12 or 24
once a week at Royal Preston Hospital, which is the major hours and is often fairly ‘full on’, but you get used to that.
trauma centre for our region. We form part of the It’s important to have supportive and understanding family
5 _______________ team with A&E doctors, anaesthetists, and friends.
general surgeons and specialist nurses. We are pre-warned
Top tips
for a big trauma and I am bleeped before ambulances,
including the air ambulance, arrive. This could be any time - find out what makes you tick early on, and make steps
of the day or night. in your chosen career direction

We aim to carry out 6 _______________ (trauma) surgery - be 12 _______________ and keep your
during the day, but there are times when operations must 13 _______________ up to date
be done at night, in which case I always keep in touch with - stay humble and be gracious to your bosses, training
my consultant. I also have about four or five sessions of you is hard work
planned surgery each week (orthopaedics). One of these is a - think what you would like your
triple session where I operate for up to 12 hours a day. 14 _______________ to say – then be that person
Some operations are very quick, for example a spinal - you’ll need to be likeable with a capacity for hard work

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UNIT 5 TRAUMA AND ORTHOPAEDICS

B SKELETAL DISORDERS AND THEIR MANAGEMENT

1 Fractures
1 The table shows several basic types of fractures. Match them with their definitions.

1 complicated A when certain bones are likely to break from repeated minor injuries

2 avulsion B the ends of a bone are driven into each other

3 spiral C a complex fracture which results in more than two bone fragments

4 comminuted D the volume of bone is reduced because it has been compressed

5 crush E accompanied by damage to regional organs and/or neurovascular bundles

6 stress F a bit of bone is pulled off with a ligament or muscle

7 impacted G one side of a bone is broken and the other is bent, most commonly seen in children

8 greenstick H seen in long bones as a result of twisting injuries

9 transverse I fracture of the skull in which (a) fragment(s) is/are pushed below the normal surface

10 compound J open fracture

11 depressed K the break is at a right angle to the long axis of the bone

2 Now look at the pictures and decide which type of fracture (listed in the table above) they represent.

1 ___________ 2 ___________ 3 ___________ 4 ___________ 5 ___________

6 ___________ 7 ___________ 8 ___________ 9 ___________ 10 ___________

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UNIT 5 TRAUMA AND ORTHOPAEDICS

3 The following items play a role in the process of fracture healing or, conversely, in bone loss as we age.
What do they mean? Find out.

angiogenesis …………………………………………………………………………………………
callus …………………………………………………………………………………………
fragility fracture …………………………………………………………………………………………
cortical (lamellar) bone …………………………………………………………………………………………
osteoblasts …………………………………………………………………………………………
osteoclasts …………………………………………………………………………………………
trabecular bone …………………………………………………………………………………………

4 Are these statements true or false? Use your knowledge of the terms from the previous task and make an
educated guess. Then watch a video about fracture healing and fractures resulting from bone loss 10 to confirm
or correct your answers.

1 The formation of a cartilaginous bridge is the first process taking place after the fracturing
of bone. T/F
2 Angiogenesis is a bone healing process in which broken vessels are repaired and restored. T/F
3 The woven bone bridging the gap between the two pieces of the broken bone is formed
by osteoblasts and osteoclasts. T/F
4 Following the callus formation, osteoclasts take over from osteoblasts and remodel the callus
to normal lamellar bone. T/F
5 Vertebral collapse is an example of fragility fracture. T/F
6 Menopause is an aggravating factor of osteoporosis. T/F
7 Trabecular bone plays the key role in contributing to hip strength. T/F

5 Immobilisation, reduction and surgery are three basic ways to treat a fractured leg. Match each procedure
with two typical key aspects8.

external frame (external fixator) attached to the broken bones with metal pins
fix bones with metal wires, plates, screws and rods
fix a splint to the leg
local anaesthetic may be used to numb the site of the fracture
plaster cast may be needed
put misaligned bones back into place

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UNIT 5 TRAUMA AND ORTHOPAEDICS

immobilisation reduction surgery


• • •

6 It is not easy to cope with the aftermath of a serious bicycle or motorcycle accident. Discuss these questions
with your colleague.

- What are the most common physical injuries which may result from a bicycle
or motorcycle accident?
- As a result of injury, people may suffer from post-traumatic stress disorder (PTSD).
What are its symptoms?
- Give tips for helping someone facing a trauma after an accident.

7 You will hear an occupational therapist, Anna Matthews, giving a presentation to a group of trainee
doctors about a patient Ted with compound (open) fractures.9 Based on your listening, summarise the
most important points under the following headings with your colleague.

1 Ted's physical and mental state on arrival to hospital


……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
2 Ted's attitude to treatment
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
3 Anna's attitude and approach to Ted's treatment
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
4 The progress of Ted's long-term therapy
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………

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UNIT 5 TRAUMA AND ORTHOPAEDICS

2 Other skeletal disorders

Here are a few examples of skeletal disorders:

osteoarthritis osteoporosis osteosarcoma Paget’s disease rheumatoid arthritis


slipped disc spina bifida sprain

Match them with the following pictures. How would you explain these conditions in your own words?

1 ______________ 2 ______________ 3 ______________ 4 ______________

5 ______________ 6 ______________ 7 ______________ 8 ______________

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UNIT 5 TRAUMA AND ORTHOPAEDICS

C EXAMINING A PATIENT
1 The words in the left part of the table are medical terms for joint movements. (These are also illustrated by the
pictures in the following exercise.) Match the terms with their definitions. 12, 13

1 circumduction a moving backwards or becoming shorter

2 abduction b act of turning the palms of the hands or soles of the feet upwards

3 retraction c movement in a circle around a fixed point away from the centre of the body

4 eversion d moving forwards

5 supination e act of turning something inwards

movement of a part of the body towards the middle of the body or towards
6 pronation f
another body part

7 internal rotation g movements of joints in a circular motion

8 adduction h act of turning something outwards or inside out

9 inversion i movement in a circle around a fixed point towards the centre of the body

rotation of the palm of the hand or sole of the foot so the inner part faces
10 protraction j
down
movement of a part of the body away from the central part of the body or
11 external rotation k
from another body part

2 Match the illustrations of joint movements (1–9) with the correct medical terms (a–k). Then choose the
appropriate patient instruction (A–K).12, 13 Note that two of the illustrations are linked to two terms
(instructions).

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UNIT 5 TRAUMA AND ORTHOPAEDICS

Medical instruction Patient instruction

a circumduction A Lift [your arm] up.

b abduction B Tilt [your head] forwards.

c adduction C Move [your feet] out.

d protraction D Make small circles with [your arm].

e pronation E Rotate [your hip] inwards.

f supination F Put [your arm] back down.

g internal rotation G Move [your feet] in.

h external rotation H Turn [your palm] down.

i eversion I Rotate [your hip] outwards.

j inversion J Turn [your palm] up.

k retraction K Tilt [your head] backwards.

1 _______ 4 _______ 7 _______


2 _______ 5 _______ 8 _______
3 _______ 6 _______ 9 _______

3 Listen to a consultation and complete the doctor's instructions. 12 What do you think the presenting
complaint was?

1 ___________________________ for me, please, Julie.


2 ___________________________ your foot down now.
3 ___________________________ lift your left leg as high as you can.
4 (Please), ___________________________ take off your shoes and your tights…
5 ___________________________ your skirt over your knee?
6 ___________________________ examine your knee.
7 ___________________________ relax your leg.
8 ___________________________ if it starts to feel uncomfortable.

Why do you think doctors tend to use this type of language for instructions in English?
Do the doctors use direct or indirect language for giving instructions in Czech/Slovak?

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UNIT 5 TRAUMA AND ORTHOPAEDICS

TERMINOLOGY BOX3

crani/o/tomy incision of the cranium

epi/physis growth upon (the end of a long bone)

kyph/osis abnormal condition of a humpback posture

lord/osis abnormal condition of a swayback posture

my/o/blast embryonic cell that develops into muscle

oste/o/clast cell that breaks down bone

oste/oma tumour composed of bone

patell/ectomy removal of the patella

scoli/osis abnormal bending of the spine

tend/o/plasty surgical repair of a tendon

LANGUAGE PRACTICE

1 Complete the gaps with words derived from the words in brackets.

a. Symptoms of post-traumatic stress disorder include: changes of personality due to brain injury;
1 ____________________ (IMPAIR) of attention and decision-making; partial or total 2 __________________
(PARALYSE); 3 __________________ (DISFIGURE); 4 __________________ (HOPE); feeling
5 __________________ (EMOTION) numb; 6 self-__________________ (DESTROY) behaviour and
7 __________________ (SUICIDE) thoughts.
b. It’s all about 1 __________________ (RECONSTRUCT) rather than resection, and by giving back people their
2 __________________ (MOBILE) you help maintain their 3 __________________ (DEPEND) and quality of
life.
c. In a displaced fracture two parts of the broken bone have moved apart, i.e. they have been
__________________. (ALIGN)
d. As a registrar I see patients with 1 __________________ (DEGENERATE) spinal conditions, spinal cord
2 __________________ (COMPRESS), nerve 3 __________________ (TRAP), and those who have injured their
backs.
e. An operation to __________________ (STRAIGHT) a spine may take up to five hours.
f. Slow-twitch fibres are __________________ (ENDURE) cells.
g. Take a deep ____________________ (BREATHE).

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UNIT 5 TRAUMA AND ORTHOPAEDICS

2 Complete the gaps in the sentences with the most suitable option (A–D).

1 The therapist worked on his patient's __________ motor skills, like writing.
A fine B delicate C subtle D light

2 The therapist always tried to come up with activities to compensate __________ the things the patient could
not do.
A to B from C for D into

3 Doctors predicted he would remain __________ a wheelchair.


A on B upon C at D in

4 Funnily enough, his disappointment became a real __________ point on his way to recovery.
A changing B twisting C turning D switching

5 After __________ from hospital, he returned to his previous job.


A displacement B disengagement C discharge D dismissal

6 Since her transplant operation she has gone from __________.


A energy to energy B force to force C strength to strength D power to power

7 Patients need to __________ charge of their own recovery.


A acquire B possess C gain D take

8 Patients need to be __________ in charge of their own recovery.


A positioned B put C posed D posted

9 The therapist is always happy to see that she can __________ a difference in the lives of her patients.
A cause B do C create D make

10 You always have to keep in __________ that patients come first.


A mind B head C memory D heart

11 They can still agree to cooperate, in __________ the new hospital wing will be built.
A that case B which case C such a case D whose case

12 In orthopaedics, you can __________ the patient with multiple fractures to full function so that they are able
to lead a normal life again.
A revive B recuperate C recover D restore

13 I'm just going to feel your shoulder __________ any fractures.


A to B for C with D at

14 And now, please __________ your head back.


A lean B slant C tilt D slope

15 This muscle allows the uterus to contract when a woman is __________ birth.
A giving B making C doing D pushing

16 Her boss taught her the basic principles and she __________ taught them her own team.
A in turn B in tandem C in fact D in force

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UNIT 5 TRAUMA AND ORTHOPAEDICS

17 More and more American teenagers reportedly __________ cosmetic surgery to beat bullies.
A undertake B resort to C initiate D enter into

USEFUL EXPRESSIONS
sb – somebody, sth – something disc disk, ploténka
A&E (accident and emergency department) slipped ~ vyhřezlá ploténka
urgentní příjem disorder porucha
abduction abdukce, odtažení musculoskeletal ~ muskuloskeletální porucha;
adduction addukce, přitažení post-traumatic stress ~ (PTSD)
air ambulance letecká záchranná služba postraumatická stresová porucha;
angiogenesis angiogeneze, neokapilarizace skeletal ~ porucha kosterní soustavy
ankle kotník emotionally numb citově otupělý
arthritis artritida, zánět kloubů eversion everze, obrácení vnitřní stranou ven
to be on call být v pohotovosti (na telefonu) factor faktor
behaviour chování aggravating ~ přitěžující faktor
aggressive ~ agresivní chování fibre vlákno
to bend one’s leg ohnout nohu (v koleně) fast-twitching ~ vlákno s rychlým záškubem;
to blink mrkat, mrknout (neúmyslně) slow-twitching ~ vlákno s pomalým záškubem
blood clot krevní sraženina foot (sg.), feet (pl.) noha (chodidlo)
blood vessel céva sole of ~ chodidlo nohy
bone kost fracture zlomenina, fraktura
broken/fractured ~ zlomená kost; collar ~ klíční avulsion ~ avulzní zlomenina, zlomenina
kost; cortical ~ kortikální kost; lamellar ~ odtržením; closed ~ zavřená zlomenina;
lamelární, vrstevnatá kost; misaligned ~ kost v comminuted ~ roztříštěná zlomenina;
nesprávné poloze; trabecular ~ trabekulární kost complicated ~ komplikovaná zlomenina;
to fix a ~ napravit kost; to realign a broken ~ compound (open) ~ otevřená zlomenina; crush ~
srovnat zlomenou kost; to straighten a ~ narovnat kompresní zlomenina; depressed ~ impresivní
kost; to weaken a ~ oslabit kost; ~ fractures kost se zlomenina; fragility ~ „zlomenina křehkých
zlomí kostí“; greenstick ~ zlomenina vrbového proutku;
breath dech impacted ~ zaklíněná zlomenina;
to take a deep ~ zhluboka se nadechnout spiral ~ spirální zlomenina; stress ~ únavová
bundle uzlík, svazek zlomenina; transverse ~ příčná zlomenina
by-product vedlejší produkt ~ of the hip zlomenina kyčle
cartilage chrupavka risk of a ~ riziko zlomeniny
cartilaginous chrupavčitý to assess a ~ posoudit zlomeninu; to cause a ~
circumduction cirkumdukce, obloukovitý pohyb způsobit zlomeninu; to suffer a ~ utrpět
to clench one's fist zatnout pěst zlomeninu
to come to terms with smířit se s, vypořádat se s ~ seen in children zlomenina vyskytující se u dětí
concussion otřes mozku goal cíl
condition nemoc, onemocnění, zdravotní stav to reach a ~ dosáhnout cíle
degenerative spinal ~ degenerativní onemocnění to grip pevně svírat, pevně uchopit
páteře hip bok
(to) cough kašel, kašlat the injured (ten) zraněný, (ti) zranění
damage poškození injury zranění, poranění
muscle ~ poškození svalů; nerve ~ poškození brain ~ poranění mozku; minor ~ menší zranění;
nervů knee ~ poranění kolene; major ~ větší, vážnější
to prevent further ~ zabránit dalšímu poškození zranění; twisting ~ zranění „kroucením“
accompanied by ~ doprovázen poškozením ~ site místo poranění
dislocation dislokace, vykloubení, vymknutí to recover from ~ zotavovat se ze zranění; to
suffer ~ utrpět poranění
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UNIT 5 TRAUMA AND ORTHOPAEDICS

inversion inverze, obrácení vnější strany dovnitř road ~ silniční vyrážka, silniční lišej
jaw čelist reference / referee zde: člověk poskytující reference o
joint kloub žadateli o pracovní místo
~ cavity kloubní dutina; ~ movement pohyb research výzkum
kloubu; ~ replacement náhrada kloubu to undertake ~ realizovat výzkum
inflammation of ~ zánět kloubu to resort to (doing) sth uchýlit se k
ligament ligamentum, vaz to rest one's arm pohodlně si položit ruku, opřít si
tear in a ~ natržení vazu ruku
menopause menopauza, trvalý zánik retraction retrakce, stažení
menstruačního cyklu rib žebro
onset of the ~ nástup menopauzy to roll up one's sleeve vyhrnout si rukáv
mobility pohyblivost, schopnost pohybu rotation rotace, otáčení
reduced ~ snížená pohyblivost external ~ externí rotace; internal ~ interní rotace
to lose ~ ztrácet pohyblivost; to regain full ~ site místo
znovu získat celkovou pohyblivost to numb the ~ of fracture umrtvit místo
morbidity morbidita, nemocnost zlomeniny
mortality mortalita, úmrtnost skill dovednost
movement pohyb fine motor ~s jemná motorika
range of ~ rozsah pohybu spina bifida zadní rozštěp páteře
neck krk, zde: krční páteř spinal cord mícha
to stabilise one's ~ stabilizovat krční páteř ~ compression komprese míchy
nerve nerv spine páteř
~ entrapment skřípnutí nervu (to) splint dlaha, dát do dlah
nurse sestra to stretch natáhnout (se)
specialist ~ specializovaná sestra study studie
orthopaedics ortopedie case ~ případová studie
osteoarthritis osteoartritida, zánět kostí a kloubů sub-specialty subspecializace
osteoblast osteoblast, buňka vytvářející kostní tkáň supination otočení ruky dlaní vzhůru
osteoclast osteoklast, mnohojaderná buňka surgeon chirurg
odbourávající kostní tkáň surgery chirurgie, chirurgický zákrok, operace
osteoporosis osteoporóza, prořídnutí kostí, orthopaedic ~ ortopedie (a chirurgie),
onemocnění kosti způsobené nadměrnou ortopedická operace
kalcifikací to carry out an emergency (trauma) ~ provést
to give rise to ~ zapříčinit osteoporózu traumatologickou operaci
placement zde: stáž, krátká pracovní zkušenost system soustava, systém
plaster cast sádra na zlomeninu autonomic nervous ~ autonomní nervový systém;
to remove a ~ sundat sádru digestive ~ trávicí soustava; muscular ~
plates, screws, rods and metal pins (related to pohybová (svalová) soustava; somatic nervous ~
orthopaedic surgery) destičky, šrouby, tyče a somatická nervová soustava (mozkomíšní nervy,
kovové kolíky (týká se ortopedické chirurgie) cerebrospinální nervová soustava)
posture držení těla team tým
to maintain one´s ~ udržet si (správné) držení těla nursing ~ ošetřující tým
progress pokrok, posun tendon šlacha
lack of ~ nedostatečný posun therapist terapeut
pronation pronace, stočení ruky s vnitřní polohou occupational ~ pracovní terapeut
palce, stočení končetiny dovnitř podél podélné trauma trauma, úraz, poranění
osy to turn over převrátit (se)
protraction protrakce, natažení, prodlužování uterus uterus, děloha
rash vyrážka vertebral column páteř

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UNIT 5 TRAUMA AND ORTHOPAEDICS

ward round vizita to remain in a ~ zůstat na vozíku


wheelchair invalidní vozík wrist zápěstí

SUPPLEMENT

Examining a patient

1 Complete the gaps with the verbs from the box.4

bend close cough grip hold lie lift


open read relax rest roll say show
stand stretch take touch turn

Example: Can you clench your fist?

A ________, please. J ________ a deep breath.


B Can you try to ________ on one leg? K Can you ________ over, please?
C And ________ your breath. L Just ________ up your sleeve, please!
D ________ me your hands please. M Could you ________ your mouth?
E ________ as far as you can. N ________ Aaaah!
F Don't worry! ________. O Can you ________ your arm here?
G Just ________ your arm, please. P Could you ________ down, please?
H Can you ________ your toes? Q Can you ________ the letters?
I You can ________ your mouth now. R Can you ________ your leg?
S ________ the bar tightly.

2 Now match the instructions with the pictures below.

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UNIT 5: TRAUMA AND ORTHOPAEDICS

REFERENCES
1 Gylys, B.A., Wedding, M.E. (2009). Medical Terminology Systems. A Body Systems Approach. F.A. Davis Company, pp. 278–282
2 https://prod-wp-content.occupationalenglishtest.org/resources/uploads/2018/06/19145654/Listening-Sample-Test-1-Audio-Script.pdf
3 https://www.askadamskutner.com/motorcycle-accident/common-injuries-and-how-to-avoid-them/
4 https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/trauma-and-orthopaedic-surgery
5 https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/trauma-and-orthopaedic-surgery/real-life-story-mr-
edward-gee
6 https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/trauma-and-orthopaedic-surgery/working-life
7 https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
8 https://www.nhs.uk/conditions/broken-leg/
9 https://www.occupationalenglishtest.org/preparation-portal/free-sample-tests/listening-sample-test-1/ (part C)
10 https://www.youtube.com/watch?v=P5HwYWShBhw
11 https://www.youtube.com/watch?v=VVL-8zr2hk4
12 McCullagh, M., Wright, R. (2007). Good Practice. Communication Skills in English for the Medical Practitioner. Student´s Book. CUP, p. 56–57
13 McCullagh, M., Wright, R. (2007). Good Practice. Communication Skills in English for the Medical Practitioner. Teacher´s Book. CUP, p. 66–67
14 Pohl, A. (2002). Professional English – Medical. Harlow: Penguin English Guides, pp. 30–31

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