This document discusses principles of fracture management. It defines fractures and classifies them as closed or open. The main types of fractures are due to injury, repetitive stress, or pathological weakening of bone. Clinical diagnosis involves history, symptoms, and radiography. Fractures are classified based on location, stability, direction, and mechanism of injury. Treatment depends on if the fracture is closed or open. Closed fractures are typically treated conservatively with splinting, casting, or traction, or surgically with internal or external fixation. Open fractures require urgent debridement, antibiotics, stabilization, and wound coverage.
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
The presentation is for the use of Physiotherapy students. It covers a brief introduction, classification, clinical features and general principles of management.
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
The presentation is for the use of Physiotherapy students. It covers a brief introduction, classification, clinical features and general principles of management.
This Presentation is on floating knee. You can also see same presentation in the form of video on my youtube channel ORTHOMECHANICS.....
You will get various lecture presentation on my channel.
Follow the link below:
https://youtu.be/8CTugwQpcoo
Complication of Tooth Extraction and their Management - Presented by Dr. Trisha and group as a part of OMS Department weekly presentation in Dhaka Dental College
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. DEFINITION OF FRACTURE
• A FRACTURE IS A BREAK IN THE STRUCTURAL CONTINUITY OF BONE.
• IF THE OVERLYING SKIN REMAINS INTACT IT IS A CLOSED (OR SIMPLE)
FRACTURE
• IF THE SKIN OR ONE OF THE BODY CAVITIES IS BREACHED IT IS AN OPEN (OR
COMPOUND) FRACTURE
• FRACTURES RESULT FROM:
1. INJURY
2. REPETITIVE STRESS
3. ABNORMAL WEAKENING OF THE BONE (A ‘PATHOLOGICAL’ FRACTURE)
4. FATIGUE OR STRESS FRACTURES
• BONE , LIKE OTHER MATERIALS , REACTS TO REPEATED LOADING .
• ON OCCASION , IT BECOMES FATIGUED & A CRACK DEVELOPS
• E.G MILITARY INSTALLATIONS , BALLET DANCERS & ATHLETES.
• A SIMILAR PROBLEM OCCURS IN INDIVIDUALS WHO ARE ON MEDICATION THAT
ALTERS THE NORMAL BALANCE OF BONE RESORPTION AND REPLACEMENT
• E.G. PATIENTS WITH CHRONIC INFLAMMATORY DISEASES WHO ARE ON
TREATMENT WITH STEROIDS OR METHOTREXATE
5. PATHOLOGICAL FRACTURES
• FRACTURES MAY OCCUR EVEN WITH NORMAL STRESSES IF THE BONE HAS
BEEN WEAKENED BY A CHANGE IN ITS STRUCTURE
• E.G. IN OSTEOPOROSIS, OSTEOGENESIS IMPERFECTA OR PAGET’S DISEASE
• OR THROUGH A LYTIC LESION
• E.G. A BONE CYST OR A METASTASIS.
7. CLINICAL FEATURES
• HISTORY OF TRAUMA
• SYMPTOMS AND SIGNS:
1. PAIN AND TENDERNESS
2. SWELLING
3. DEFORMITY
4. CREPITUS
5. LOSS OF FUNCTION
6. NERVE AND VASCULAR INJURY
8.
9. RADIOGRAPHIC FINDINGS
• PLAIN X-RAY SHOULD SHOW JOINT ABOVE AND JOINT BELOW IN AT LEAST 2
VIEWS, SPECIAL VIEW ON REQUEST
• CT SCAN
• MRI IT IS NOT HELPFUL IN FRACTURE DIAGNOSIS OTHER THAN DELINEATING
ASSOCIATED INJURIES TO THE CNS , SUBTROCHANTERIC (ST) DISRUPTION OR
OCCASIONALLY FATIGUE FRACTURE
10. FRACTURE CLASSIFICATION
• ANATOMICAL LOCATION
• CONDITION OF OVERLYING ST
• DIRECTION OF FRACTURE LINE
• MECHANISM OF INJURY
• WHETHER THE FRACTURE IS LINEAR OR COMMINUTED
• AO CLASSIFICATION
21. TREATMENT OF CLOSED
FRACTURES
•EMERGENCY CARE (SPLINTING)
•DEFINITIVE FRACTURE TREATMENT
•REHABILITATION (MUSCLE ACTIVITY AND
EARLY WEIGHTBEARING ARE
ENCOURAGED)
22. EMERGENCY CARE (SPLINTING)
• SPLINT THEM WHERE THEY LIE
• ADEQUATE SPLINTING IS DESIRABLE
• TYPE OF SPLINTS:
• IMPROVISED
• CONVENTIONAL
23. DEFINITIVE FRACTURE TREATMENT
• THE GOAL OF FRACTURE TREATMENT IS TO OBTAIN UNION OF
THE FRACTURE IN THE MOST ANATOMICAL POSITION COMPATIBLE
WITH MAXIMAL FUNCTIONAL RETURN OF THE EXTREMITY
• 2 TYPES OF DEFINITIVE FRACTURE TREATMENT:
• CONSERVATIVE
• SURGICAL
24. CONSERVATIVE
• REDUCTION: IF DISPLACED UNDER GENERAL ANASTHESIA, THE SOONER
THE BETTER
• STEPS OF REDUCTION:
• TRACTION
• ALIGN (WHICH FRAGMENT)
• REVERSE MECHANISM OF INJURY
• IMMOBILIZATION: POP (PLASTER OF PARIS) CAST, SLAB, TRACTION (FIXED OR
BALANCED)
• REHABILITATION
32. OPEN REDUCTION INDICATIONS
• OPERATIVE REDUCTION OF THE FRACTURE IS
INDICATED:
1.WHEN CLOSED REDUCTION FAILS
2.WHEN THERE IS A LARGE ARTICULAR FRAGMENT
THAT NEEDS ACCURATE POSITIONING
3.FOR TRACTION (AVULSION) FRACTURES IN WHICH
THE FRAGMENTS ARE HELD APART
33. INTERNAL FIXATION INDICATION
1. FRACTURES THAT CANNOT BE REDUCED EXCEPT BY OPERATION
2. FRACTURES THAT ARE INHERENTLY UNSTABLE AND PRONE TO RE-DISPLACE
AFTER REDUCTION
3. FRACTURES THAT UNITE POORLY AND SLOWLY
4. PATHOLOGICAL FRACTURES IN WHICH BONE DISEASE MAY PREVENT
HEALING
5. MULTIPLE FRACTURES WHERE EARLY FIXATION REDUCES THE RISK OF
GENERAL COMPLICATIONS AND LATE MULTISYSTEM ORGAN FAILURE
6. FRACTURES IN PATIENTS WHO PRESENT NURSING DIFFICULTIES
34. TYPE OF INTERNAL FIXATION
• INTERFRAGMENTARY SCREWS
• WIRES (TRANSFIXING, CERCLAGE AND TENSION-
BAND)
• PLATES AND SCREWS
• INTRAMEDULLARY NAILS
35. PLATES AND SCREWS
• PLATES HAVE FIVE DIFFERENT FUNCTIONS:
1. NEUTRALIZATION
• TO BRIDGE A FRACTURE AND SUPPLEMENT THE EFFECT OF INTERFRAGMENTARY LAG SCREWS
2. COMPRESSION
• USED IN METAPHYSEAL FRACTURES WHERE HEALING ACROSS THE CANCELLOUS FRACTURE
GAP MAY OCCUR DIRECTLY
3. BUTTRESSING
• ‘OVERHANG’ OF THE EXPANDED METAPHYSES OF LONG BONES
4. TENSION-BAND
• ALLOWS COMPRESSION TO BE APPLIED TO THE BIOMECHANICALLY MORE ADVANTAGEOUS
SIDE OF THE FRACTURE
5. ANTI-GLIDE
• TO PREVENT SHORTENING AND RECURRENT DISPLACEMENT OF THE FRAGMENTS
38. AN OBLIQUE FRACTURE OF THE SHAFT OF THE FEMUR, BEFORE AND AFTER REAMED
INTRAMEDULLARY FIXATION WITH A STOUT NAIL AND INTERLOCKING SCREWS. THIS TREATMENT
ALLOWS NEAR IMMEDIATE AMBULATION FOR THE PATIENT.
39. EXTERNAL FIXATION
• INDICATIONS:
1. FRACTURES ASSOCIATED WITH SEVERE SOFT-TISSUE DAMAGE (INCLUDING OPEN
FRACTURES) OR THOSE THAT ARE CONTAMINATED
2. FRACTURES AROUND JOINTS THAT ARE POTENTIALLY SUITABLE FOR INTERNAL
FIXATION BUT THE SOFT TISSUES ARE TOO SWOLLEN TO ALLOW SAFE SURGERY
3. PATIENTS WITH SEVERE MULTIPLE INJURIES
4. UNUNITED FRACTURES, WHICH CAN BE EXCISED AND COMPRESSED
5. INFECTED FRACTURES
40.
41. REHABILITATION
• RESTORE FUNCTION – NOT ONLY TO THE INJURED PARTS BUT
ALSO TO THE PATIENT AS A WHOLE
• THE OBJECTIVES ARE:
1. TO REDUCE OEDEMA
2. PRESERVE JOINT MOVEMENT
3. RESTORE MUSCLE POWER
4. GUIDE THE PATIENT BACK TO NORMAL ACTIVITY
42.
43. TREATMENT OF OPEN FRACTURES
•INITIAL MANAGEMENT
•CLASSIFYING THE INJURY
•DEFINITIVE TREATMENT
44. INITIAL MANAGEMENT
• IT IS ESSENTIAL THAT THE STEP-BY-STEP APPROACH IN ADVANCED TRAUMA LIFE
SUPPORT NOT BE FORGOTTEN
• WHEN THE FRACTURE IS READY TO BE DEALT WITH:
1. THE WOUND IS CAREFULLY INSPECTED
2. ANY GROSS CONTAMINATION IS REMOVED
3. THE WOUND IS PHOTOGRAPHED
4. THE AREA THEN COVERED WITH A SALINE-SOAKED DRESSING
5. THE PATIENT IS GIVEN ANTIBIOTICS
6. TETANUS PROPHYLAXIS IS ADMINISTERED
7. THE LIMB CIRCULATION AND DISTAL NEUROLOGICAL STATUS CHECKED REPEATEDLY
45. CLASSIFYING THE INJURY
• WITH GUSTILO’S CLASSIFICATION OF OPEN FRACTURES (GUSTILO ET AL.,
1984):
• TYPE 1 – THE WOUND IS USUALLY A SMALL, CLEAN PUNCTURE THROUGH WHICH
A BONE SPIKE HAS PROTRUDED. THERE IS LITTLE SOFT-TISSUE DAMAGE WITH NO
CRUSHING AND THE FRACTURE IS NOT COMMINUTED (I.E. A LOW-ENERGY
FRACTURE).
• TYPE II – THE WOUND IS MORE THAN 1 CM LONG, BUT THERE IS NO SKIN FLAP.
THERE IS NOT MUCH SOFT-TISSUE DAMAGE AND NO MORE THAN MODERATE
CRUSHING OR COMMINUTION OF THE FRACTURE (ALSO A LOW- TO MODERATE-
ENERGY FRACTURE).
• TYPE III – THERE IS A LARGE LACERATION, EXTENSIVE DAMAGE TO SKIN AND
46. CLASSIFYING THE INJURY
• THERE ARE THREE GRADES OF SEVERITY:
• TYPE III A THE FRACTURED BONE CAN BE ADEQUATELY COVERED BY SOFT
TISSUE DESPITE THE LACERATION.
• TYPE III B THERE IS EXTENSIVE PERIOSTEAL STRIPPING AND FRACTURE
COVER IS NOT POSSIBLE WITHOUT USE OF LOCAL OR DISTANT FLAPS.
• TYPE III C THERE IS AN ARTERIAL INJURY THAT NEEDS TO BE REPAIRED,
REGARDLESS OF THE AMOUNT OF OTHER SOFT-TISSUE DAMAGE
47. PRINCIPLES OF TREATMENT
• ALL OPEN FRACTURES, NO MATTER HOW TRIVIAL THEY MAY
SEEM, MUST BE ASSUMED TO BE CONTAMINATED
• THE FOUR ESSENTIALS ARE:
1. ANTIBIOTIC PROPHYLAXIS.
2. URGENT WOUND AND FRACTURE DEBRIDEMENT.
3. STABILIZATION OF THE FRACTURE.
4. EARLY DEFINITIVE WOUND COVER.
48.
49. WOUND EXTENSIONS FOR
ACCESS IN OPEN
FRACTURES OF THE TIBIA
WOUND INCISIONS (EXTENSIONS) FOR ADEQUATE
ACCESS TO AN OPEN TIBIAL FRACTURE ARE MADE
ALONG STANDARD FASCIOTOMY INCISIONS: 1 CM
BEHIND THE POSTEROMEDIAL BORDER OF THE TIBIA
AND 2–3 CM LATERAL TO THE CREST OF THE TIBIA AS
SHOWN IN THIS EXAMPLE OF A TWO-INCISION
FASCIOTOMY. THE DOTTED LINES MARK OUT THE CREST
(C) AND POSTEROMEDIAL CORNER (PM) OF THE TIBIA
THESE INCISIONS AVOID INJURY TO THE PERFORATING
BRANCHES THAT SUPPLY AREAS OF SKIN THAT CAN BE
USED AS FLAPS TO COVER THE EXPOSED FRACTURE
THIS CLINICAL EXAMPLE SHOWS HOW LOCAL SKIN
NECROSIS AROUND AN OPEN FRACTURE IS EXCISED
AND THE WOUND EXTENDED PROXIMALLY ALONG A
50.
51. • THE EXTERNAL FIXATOR MAY BE EXCHANGED FOR INTERNAL FIXATION AT THE TIME OF
DEFINITIVE WOUND COVER AS LONG AS:
1. THE DELAY TO WOUND COVER IS LESS THAN 7 DAYS
2. WOUND CONTAMINATION IS NOT VISIBLE
3. INTERNAL FIXATION CAN CONTROL THE FRACTURE AS WELL AS THE EXTERNAL FIXATOR
52. AFTERCARE
• IN THE WARD, THE LIMB IS ELEVATED AND ITS CIRCULATION
CAREFULLY WATCHED.
• ANTIBIOTIC COVER IS CONTINUED BUT ONLY FOR A MAXIMUM OF
72 HOURS IN THE MORE SEVERE GRADES OF INJURY
• WOUND CULTURES ARE SELDOM HELPFUL, IF IT WERE TO ENSUE,
IS OFTEN CAUSED BY HOSPITAL-DERIVED ORGANISMS
53. REFERENCES
1. SOLOMON L, WARWICK DJ, NAYAGAM S. APLEY’S SYSTEM OF ORTHOPAEDICS
AND FRACTURES. CRC PRESS; 2010.
2. F. CHARLES BRUNICARDI, DANA K. ANDERSEN, TIMOTHY R. BILLIAR, DAVID L.
DUNN, JOHN G. HUNTER, RAPHAEL E. POLLOCK, ET AL. SCHWARTZ’S
PRINCIPLES OF SURGERY. 9TH ED. NEW YORK/US: MCGRAW-HILL EDUCATION
- EUROPE; 2009.