A 30-year-old Thai man was brought to the emergency room 15 minutes after a motor vehicle accident. He was unresponsive with a blood pressure of 80/50 mmHg and pulse of 120/min. A pelvic compression test was positive and his right leg was 3 cm shorter. Initial management included resuscitation with Ringer's lactate and oxygen, monitoring of vital signs, and pain control. Imaging found a fracture of the right pubic rami and left sacrum. The pelvic fracture was classified as Type B or C, indicating rotational and vertical instability. Management included immobilization with a pelvic binder and potential open reduction and internal fixation surgery.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
Overuse injuries to the elbow in the throwing athlete are frequent. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on athletes from all levels of competition.
The purpose of this study is to review all ulnar collateral ligament reconstructions performed at a single institution between January 2004 – July 2014. The study reported patient demographics, clinical outcomes, return to sport rate and complications.
Principles of Management of the multiply injured patientCHRIS ALUMONA
The multiply injured or polytraumatised patient is at a greater risk of morbidity and mortality than patients with isolated injuries. This risk is greater than the sum of the risks of their individual injuries. A high index of suspicion is needed to recognise immediately life threatening injuries and promptly address them. The principles of management is captured with the ATLS protocol and every trauma surgeon should be conversant with this indispensable tool.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
Overuse injuries to the elbow in the throwing athlete are frequent. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on athletes from all levels of competition.
The purpose of this study is to review all ulnar collateral ligament reconstructions performed at a single institution between January 2004 – July 2014. The study reported patient demographics, clinical outcomes, return to sport rate and complications.
Principles of Management of the multiply injured patientCHRIS ALUMONA
The multiply injured or polytraumatised patient is at a greater risk of morbidity and mortality than patients with isolated injuries. This risk is greater than the sum of the risks of their individual injuries. A high index of suspicion is needed to recognise immediately life threatening injuries and promptly address them. The principles of management is captured with the ATLS protocol and every trauma surgeon should be conversant with this indispensable tool.
Case presentation of Orthopedic Cse Anaesthesia ManagementMr.Harshad Khade
A 43 year old male patient was transferred with an ambulance in the emergency department of the hospital with bleeding from right thigh after a motorcycle accident. He had become a trapped under the motorcycle.
Discuss the medical, surgical and anesthetic management of this patient.
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
A 43 year old male patient was transferred with an ambulance in the emergency department of the hospital with bleeding from right thigh after a motorcycle accident. He had become a trapped under the motorcycle.
Discuss the medical, surgical and anesthetic management of this patient.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
2. Pelvic injury with hypovolumic shock
ผู้ป่วยชายไทยอายุ 30 ปี ประสบอุบัติเหตุจราจร 15 นาที ก่อนมา
โรงพยาบาล ไม่รู้สึกตัว ตรวจร่างกาย BP 80/50 mmHg pulse 120/min
pelvic compression test +ve ขาขวาสั้นกว่าอีกข้าง 3 ซม.
3. Initial management
• Primary survey
• Resuscitation
– Ringer lactate solution
– Oxygen supplement : Mask with bag 10 LPM
• Monitor
– Vital sign
– Retain foley’s catheter observe bleeding per
meatus before catheterize
• Pain control
4. Investigation
• FAST
• Blood for CBC, Coagulogram, G/M ,Hct stat
• Film pelvis AP
Fracture of right both pubic rami and left side of
sacrum
• Film pelvis inlet,outlet
• CT, CTA if vital signs unstable after sufficient
resuscitation
6. Modified Tile AO Müller classification
• Type A: stable - posterior arch is intact
• Type B: rotationally unstable, vertically stable -
incomplete disruption of the posterior arch
• Type C: rotationally and vertically unstable -
complete disruption of the posterior arch
Type B, Type C Unstable pelvic fracture
9. Management
• immobilization of fractures
• Pelvic binder (tamponade effect)
• Closed reduction and external fixation
– C clamp, Distal femoral traction
• Set OR for open reduction and internal
fixation (definite treatment)
True length วัดจาก asis ไป lat malleolus
Apparent วัดจากสะดือไป lat malleolus
Type Description Type A: stable - posterior arch is intact A1: fracture does not involve the pelvic ring (avulsion fracture or fracture of the iliac wing) - A1.1: iliac spine - A1.2: iliac crest - A1.3: ischial tuberosity A2: stable or minimally displaced fracture of the pelvic ring - A2.1: iliac wing fractures - A2.2: unilateral fracture of anterior arch - A2.3: bifocal fracture of anterior arch A3: transverse fracture of the sacrum - A3.1: sacrococcygeal dislocation - A3.2: sacrum undisplaced - A3.3: sacrum displaced Type B: rotationally unstable, vertically stable - incomplete disruption of the posterior arch B1: open book injury (external rotation) - B1.1: sacroiliac joint, anterior disruption - B1.2: sacral fracture B2: lateral compression injury (internal rotation) - B2.1: anterior compression fracture, sacrum - B2.2: partial sacroiliac joint fracture, subluxation - B2.3: incomplete posterior iliac fracture B3: bilateral type B fracture - B3.1: bilateral open book fracture - B3.2: open book fracture and lateral compression - B3.3: bilateral lateral compression Type C: rotationally and vertically unstable - complete disruption of the posterior arch C1: unilateral fracture - C1.1: fracture of the iliac bone - C1.2: sacroiliac dislocation and/or fracture dislocation - C1.3: sacral fracture C2: bilateral fracture with one side type B fracture (rotationally unstable) and one side type C fracture (vertically unstable) C3: bilateral fracture with both sides type C fracture (both sides completely unstable)
APC I Symphysis widening < 2.5 cm Non-operative. Protected weight bearing
APC II Symphysis widening > 2.5 cm. Anterior SI joint diastasis . Posterior SI ligaments intact. Disruption of sacrospinous and sacrotuberous ligaments. Anterior symphyseal plate or external fixator +/- posterior fixation
APC III Disruption of anterior and posterior SI ligaments (SI dislocation). Disruption of sacrospinous and sacrotuberous ligaments. APCIII associated with vascular injury Anterior symphyseal multi-hole plate or external fixator and posterior stabilization with SI screws or plate/screws
Lateral Compression (LC) LC Type I Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture. Non-operative. Protected weight bearing (complete, comminuted sacral component. Weight bearing as tolerated (simple, incomplete sacral fracture).
LC Type II Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture). Open reduction and internal fixation of ilium
LC Type III Ipsilateral lateral compression and contralateral APC (windswept pelvis). Common mechanism is rollover vehicle accident or pedestrian vs auto. Posterior stabilization with plate or SI screws as needed. Percutaneous or open based on injury pattern and surgeon preference.
Vertical Shear (VS) Vertical shear Posterior and superior directed force. Associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25% Posterior stabilization with plate or SI screws as needed. Percutaneous or open based on injury pattern and surgeon preference.
http://www.orthobullets.com/trauma/1030/pelvic-ring-fractures
