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Video tags
Subtitles
Russian
00:00:02
[music]00:00:16
panic attack a sudden attack of00:00:18
anxiety with vivid autonomic00:00:20
symptoms repeated panic00:00:22
episodes cause suffering to patients00:00:24
leading to escapist behavior and00:00:26
social maladaptation sees rox00:00:28
is used as a symptomatic00:00:29
remedy for panic attacks00:00:31
somatoform autonomic dysfunction of the00:00:32
sympathoadrenal type active00:00:35
substance sees roxa prophet san00:00:36
belongs to the alpha class - adrenergic blockers00:00:38
prophet san reduces the excitability of the00:00:40
dance structures of the brain regulates the00:00:42
tone of the sympathoadrenal system00:00:44
see rocks effectively stop00:00:46
panic attacks does not have a00:00:48
psychotropic effect does not cause00:00:50
drowsiness and addiction sees rocks00:00:53
first aid for panic attacks00:00:58
well-proven sildenafil is00:01:01
now in spray format 12 and a half00:01:05
milligrams of active ingredient in00:01:07
one when pressed,00:01:08
it works within 10 minutes00:01:11
unprecedented dosing flexibility00:01:15
James new format new possibilities00:01:23
dimexide gel a modern form of a00:01:26
proven medicinal product with00:01:28
analgesic and anti-inflammatory00:01:30
effects00:01:32
now in a new package00:01:34
dimexide gel is used in the complex00:01:36
treatment of arthritis and arthrosis,00:01:38
radiculitis, thrombophlebitis, bruises and00:01:41
sprains00:01:43
dimexide gel deeply and quickly penetrates00:01:46
into tissues and increases skin permeability00:01:49
to other medications00:01:51
enhances and accelerates the action of external00:01:54
forms of non-steroidal anti-inflammatory00:01:56
drugs heparin and venotonics00:01:59
has low toxicity has no side00:02:01
effects on the gastrointestinal tract00:02:04
is a safe alternative to NSAIDs in00:02:07
patients with chronic kidney disease and00:02:10
diseases of the gastrointestinal tract00:02:13
dimexide gel quick help for pain and00:02:16
inflammation00:02:18
[music]00:02:21
dear colleagues good afternoon, I am00:02:23
glad to welcome you today to our00:02:25
next lecture and00:02:28
talk about what00:02:30
was my life for quite a00:02:33
long period, this is traumatology and00:02:35
orthopedics because for a very long time it’s scary00:02:39
to say when in 1997 I was scared an00:02:42
intern girl crossed the threshold00:02:44
of the emergency room in the Petrograd region and this00:02:47
radically changed my outlook on life and00:02:50
gave me the firm confidence that everything in00:02:52
this life is changing, but the edges of idiocy are00:02:54
endless, and so traumatology and00:02:57
orthopedics are one of the most difficult topics in00:03:01
medicine, since trauma00:03:05
is what we face everyone at any00:03:08
age, one way or another, bruises,00:03:13
wounds, cuts, fractures and dislocations and subluxations, we00:03:18
encounter this quite00:03:20
often and literally from a very early00:03:23
age, what should be understood and remembered00:03:27
before when we talk about injury, first of00:03:30
all,00:03:31
this is everywhere the second00:03:35
description of a doctor anywhere in the world - the radiologist00:03:37
should understand precisely the need to00:03:40
understand traumatic changes outside of a00:03:45
foreign language and any other00:03:47
language, understanding the language of traumatology,00:03:50
which entails the formulation of the00:03:53
same00:03:55
medical aid to the same00:03:58
plate of spokes, and so on, led to the00:04:01
formation and development of the00:04:03
Watt classification according to which we use today we will00:04:06
also talk today we will00:04:09
talk only about radiology, I00:04:12
fundamentally moved MRI beyond the scope of00:04:14
this lecture, although00:04:18
magnetic resonance00:04:20
imaging is extremely important in diagnosing injuries of00:04:22
soft tissue structures, I want to go back to00:04:25
the time when we had an00:04:28
x-ray in our hands moreover, why is00:04:30
this important? Again, everyone has encountered00:04:33
trauma in everyday life, and our children, our00:04:36
parents, perform conventional x-ray00:04:40
examination, its capabilities, the principles of the method,00:04:43
features that are related to00:04:45
traumatology, I would really like to00:04:47
talk about it today in one lecture, as00:04:50
you understand, it is impossible to outline even00:04:53
all the features of the injury00:04:55
one single knee joint,00:04:57
so today we will try to00:04:59
review the classification, but since00:05:05
in our practice at 1 medical00:05:06
university we were faced with the fact that a00:05:09
patient came for a consultation with an00:05:12
alphanumeric diagnosis in which I will be00:05:15
honest, I didn’t understand anything, he00:05:17
came from Switzerland and brought me his00:05:19
medical history where00:05:22
the radiologist wrote only a letter and00:05:25
a few numbers, now we will talk about00:05:28
how we can understand in this complex00:05:31
alphanumeric sequence what we are00:05:33
talking about, and so we have an00:05:37
excellent national manual on00:05:39
traumatology, it was written in 2008 and00:05:42
it is not probably outdated because00:05:45
despite the fact that time changes,00:05:47
treatment methods change, the injury as00:05:50
such remains the same injury as it00:05:52
was before, that we must remember,00:05:56
examination of a patient with injury or its00:05:59
consequences consists of a complaint and00:06:02
anamnesis of the injury, examination of palpation and00:06:05
percussion and auscultation,00:06:07
determination of volume movements in the joints,00:06:09
measuring the length of the limb, determining the00:06:12
muscle strength of the function of the limb, and00:06:15
only after that they resort to choosing00:06:17
additional research methods,00:06:19
laboratory X-ray,00:06:22
ultrasound, and so on, as it is written00:06:24
in the national manual, and I can00:06:27
tell you that almost no one wants to00:06:30
talk about trauma and traumatology00:06:33
if it’s in front of their eyes The doctor does not have an00:06:35
x-ray of the gt or an MRI of the00:06:38
injured limb;00:06:40
in any case, our method is used and00:06:44
is used constantly when in the00:06:47
diagnosis of a fracture in the diagnosis of00:06:49
dislocations and subluxations in the diagnosis of00:06:51
damage to the soft tissues of the muscular and00:06:53
ligamentous apparatus, this is primarily00:06:56
magnetic resonance imaging and, of course, the00:06:58
diagnosis of damage to the00:07:00
joints and joint capsules,00:07:03
all the methods that we talked about in00:07:05
our first lectures are used in00:07:07
full, and radiography and00:07:10
fluoroscopy and computed tomography,00:07:12
magnetic resonance imaging and everything are00:07:15
naturally not so widespread, however,00:07:18
ultrasound examination occupies a00:07:19
huge place; without00:07:24
this method, modern and00:07:26
timely most the main thing is the diagnosis of00:07:29
traumatology to change and so00:07:31
let's talk a little about dislocations luxation00:07:34
persistent separation of articulating00:07:36
surfaces as a result of physical00:07:37
violence or a pathological process00:07:41
the name of the dislocation how to correctly00:07:43
name the dislocation you have recently00:07:47
in your work in advisory work we00:07:50
began to encounter the fact that you00:07:52
call them in a strange way we They must00:07:56
remember that the name dislocation is given to a00:07:58
semi-damaged joint, that is, a dislocation00:08:02
in the shoulder joint, a00:08:03
subluxation in the elbow joint, but in no00:08:07
case a dislocation of the shoulder joint, this is00:08:10
incorrect in Russian, it sounds in00:08:13
such and such a joint, or the00:08:17
underlying segment other than the00:08:19
collarbone and vertebrae is considered inverted. there is a00:08:23
dislocation of00:08:25
the tibia and fibula in00:08:28
relation to the femur these are terms and00:08:31
we will talk in terms all the time00:08:34
since modern terminology00:08:37
has changed somewhat even compared to00:08:40
the time when00:08:42
it was taught to me00:08:45
subluxation the separation of congruent00:08:48
surfaces not over the entire area of the00:08:50
articular surface so the most complex00:08:55
joints in determining the dislocation and subluxation of the00:08:59
temporomandibular joints the largest00:09:01
number of different complaints that00:09:04
arise in these patients00:09:07
temporomandibular joints pain when00:09:09
chewing unpleasant sensations of heaviness00:09:12
painful sensations all this can00:09:15
occur in this group of patients00:09:18
and so subluxation subluxation is determined by the00:09:23
displacement of the head of the joints to the top of the00:09:26
articular tubercle00:09:27
we can check this by asking the patient00:09:30
to open his mouth, this can be done with an00:09:33
x-ray examination, however, there will be00:09:35
much worse qualities optimally00:09:37
computed tomography, while we do not00:09:39
ask the patient to open his mouth as00:09:41
if he was swallowing a tennis ball before or,00:09:44
God forbid, he is training in swallowing a00:09:46
light bulb.00:09:48
By the way, such patients came to In the00:09:52
90s, in trauma centers, we00:09:53
also saw this, even we have photographs of00:09:57
individual individuals of the human race with light00:09:58
bulbs in the oral cavity, and so00:10:01
subluxation of the joint on the head, articular00:10:06
complete dislocation when you and I see the00:10:10
head going beyond the limits of the articular tubercle,00:10:14
the patient complains of pain syndrome00:10:18
dizziness, inability to00:10:21
sleep comfortably when relaxing the muscles, he00:10:24
has a feeling of00:10:25
nagging aching pain along the front00:10:28
surface of the ear, the list of complaints is huge and00:10:31
in this case00:10:33
we will carry out a differential diagnosis with a very interesting00:10:35
condition; we will look for00:10:38
mastoid syndrome in our patient before the awl, and in00:10:41
this case we will definitely Let's look at the00:10:45
styloid processes of our patient00:10:49
in this case, they are not elongated, they have a00:10:52
normal shape, they are00:10:54
not adjacent to the00:10:56
existing nearby vascular structures00:10:59
and we can safely say that his00:11:01
condition is caused precisely by the situation of the00:11:04
temporal mandibular joint, but what00:11:07
should be remembered is the visualization of the meniscus in00:11:10
this joint only magnetic resonance00:11:12
imaging00:11:14
second a situation that, again, we00:11:17
very often encounter, a patient is sent to us00:11:19
with a mystical diagnosis of00:11:22
trauma received at birth,00:11:27
it is necessary to evaluate the relationship in the atlas00:11:30
and motley of the real joint, it is important that we00:11:33
must be able to measure we must00:11:35
measure the distance between the tooth, the prominent00:11:39
process, its lateral surfaces on00:11:40
the right and on the left and the lateral masses of the00:11:45
atlas, in this situation a difference of more00:11:50
than two millimeters can give a00:11:52
certain clinical picture, but we should not00:11:54
forget that the00:11:56
total width of the spinal canal should also be simultaneously assessed00:12:00
at the level of the described00:12:03
changes if our patient has00:12:06
minimal dislocation, as in this00:12:09
case it should always be pay attention00:12:11
to the possibility of concomitant pathology in00:12:14
this case, this is non-fusion of other00:12:17
cervical vertebrae and we see spina00:12:20
bifida in the cervical spine;00:12:23
it has several vertebrae with similar00:12:25
splitting; this is an accidental finding;00:12:28
we previously performed radiographs00:12:31
through the mouth in this situation, identifying dislocations00:12:33
and subluxations of the atlas and quickly in a real00:12:35
joint, however, modern radiation00:12:38
diagnostics allows, with competent and00:12:40
correct placement, to perform00:12:41
computed tomography with the construction of00:12:43
both three-dimensional and00:12:45
multi-planar reconstructions, that is, to measure the entire00:12:47
angle of inclination of the tooth of the prominent process, the00:12:50
distance between the lateral masses and the tooth are00:12:53
visible in the sailor’s eye and a final00:12:55
diagnosis can often00:12:58
be made perform this study before00:13:01
prescribing aggressive00:13:04
manual therapy to the patient, especially if this is a00:13:06
patient over the age of 70 who00:13:09
comes to us with a completely mystical00:13:11
diagnosis of subluxation of the atlas and00:13:14
variegated fiolent constitution received in00:13:16
childhood, due to which he is prescribed the00:13:18
following physiotherapy or, alas,00:13:23
how to look for orthopedic massage00:13:27
and other activities in this case,00:13:30
having massive calcification of the vertebral00:13:32
arteries, you can achieve00:13:34
unique results in the patient in terms of possible00:13:36
complications, this should be remembered00:13:39
how dislocations are classified into00:13:42
congenital and acquired00:13:44
traumatic pathological and habitual00:13:47
dislocations,00:13:49
dislocations can be in completely unique00:13:52
places and here if to you a00:13:54
patient comes with a dislocation, especially a young00:13:56
patient, you should carefully00:13:59
collect a pineapple from him, what is he doing00:14:02
and where could he get this from, you00:14:05
or two of them in this case, in front of us is00:14:08
the leg of a young football player00:14:10
who had a great time after00:14:13
training, they were running barefoot on the grass00:14:15
with friends in a great mood, they hit a00:14:18
hard ball and now we have the result of00:14:21
this event of absolutely stunning00:14:24
beauty, complete dislocation in the interphalangeal00:14:27
joint, 3 toes of the left foot,00:14:31
amazing observation, it is extremely rare for00:14:33
someone to achieve such00:14:34
results, why do I believe that our00:14:37
patient is a football player, pay attention to00:14:40
him nail tubercles they look00:14:43
very specific, flat, quite00:14:45
wide where the leg comes into contact with the00:14:50
ball, I remind you once again that the00:14:51
osteoarticular apparatus can tell us a00:14:53
lot about a person,00:14:56
classification of dislocations, what are we talking about00:14:59
in terms of time, these can be fresh dislocations00:15:02
when no more has passed since the injury 300:15:04
days not fresh dislocations from 3 days to 300:15:08
weeks and old ones when00:15:10
more than three weeks have passed since the dislocation and00:15:14
here is a variant of the island of dislocation looking at00:15:17
which again the young man00:15:20
wants to ask who he insulted00:15:23
during the injury before in this00:15:26
case us, a very beautiful picture of a00:15:30
dislocation, a complete dislocation of the middle bear,00:15:34
langa, in your joint, 3 fingers of the right hand,00:15:37
saying that, in general, politeness has never00:15:40
spoiled anyone’s life, probably you00:15:42
shouldn’t be rude to the people sitting with you at the00:15:45
same table, look in a direct00:15:48
projection, we see the overlay of the00:15:50
shadow of the phalanges, friend on a friend goes well to the00:15:55
board, however, you should00:15:56
remember a very important thing that we00:15:59
persistently try to instill in all my colleagues in our classes on00:16:00
traumatology to00:16:03
students of 3 4 years if your colleague00:16:06
plays volleyball and dislocated his finger, do not00:16:09
grab it and tug manically,00:16:11
especially when asking colleagues to command to00:16:14
hold the victim’s hand,00:16:15
yes, in this way you tear the ligamentous00:16:18
apparatus in tear the joint capsule,00:16:20
there are rules for the reduction of dislocations,00:16:24
especially fresh dislocations, and these are the00:16:27
manipulations performed using00:16:30
local or general anesthesia,00:16:32
since only in this case we achieve00:16:34
complete relaxation of the muscles the second moment of the00:16:38
dislocated segment they are adjusted in the most00:16:41
gentle way without jerking or brute00:16:44
force until beach volleyball, these are00:16:46
absolutely fanatical attempts to correct00:16:48
dislocations for which, again, young people are famous;00:16:55
mandatory immobilization after00:16:58
adjusting the dislocation, again only in00:17:00
Hollywood films, Mel Gibson can00:17:04
get a dislocation in the shoulder joint,00:17:06
get out of the ropes, then adjust this00:17:09
dislocation on your own and going with this00:17:12
hand means heroically crushing enemies in00:17:15
real life, this is impossible,00:17:17
after removing the physical fixing00:17:20
bandage, a long course of rehabilitation treatment is carried out, this includes00:17:24
gymnastics and physiotherapy and the00:17:27
introduction of treatment mechanotherapy aimed00:17:30
at relieving pain, normalizing00:17:32
blood circulation and increasing the elasticity of00:17:34
soft tissues, remind again yes this is00:17:37
our rule set out in the national00:17:40
manual that is required to be respected and00:17:43
respected, the most important thing is to observe in the name00:17:46
of the shoulder joint before and after reduction,00:17:48
please look at the most difficult00:17:50
situation when it occurs not only00:17:53
by identifying, but also by wedging of the00:17:55
articular surface of the scapula and the lower00:17:58
edge into the head of the humerus, this one00:18:02
dislocation without the use of sedation00:18:05
painkillers, muscle relaxant procedures, it is00:18:07
almost impossible to correct; moreover, the00:18:10
patient will be left with this00:18:12
specific depressed fracture, which00:18:15
we will be able to see even after many years,00:18:17
and I’m not talking about the fact that he most00:18:20
likely has a rupture of the rotator cuff00:18:23
in such situations without it is extremely00:18:26
rarely avoided and you and I00:18:29
can and should be able to check this, we ask00:18:32
the patient to stand in front of us, then00:18:34
lean forward and from a00:18:36
forward bending position up to 90 degrees, raise his00:18:39
arms forward if the patient does this, the00:18:42
rotator cuff can be intact if,00:18:45
alas, we don’t have there are traumatic00:18:47
changes in this segment of the limb, and00:18:50
so00:18:52
just a few words about dislocations;00:18:54
dislocations are perfectly diagnosed by00:18:56
x-ray if the patient has the00:19:00
opportunity to adequately complain about them;00:19:01
in addition, anything detected in00:19:04
any joint is visible visually; everything that00:19:07
needs to be looked at carefully is00:19:09
to assess the degree of prescription of this dislocation,00:19:13
since old dislocations are often00:19:15
require surgical intervention and under00:19:18
no circumstances should you ever grab onto a00:19:21
dislocated limb or pull it with00:19:23
all your might. Unfortunately, over the past 5 years,00:19:27
I have been taught by three 3rd00:19:30
year students of our university, who are00:19:33
colleagues on sports teams. You are also00:19:36
students of the 1st medical university.00:19:38
In this way, they tried to reduce the00:19:40
dislocations, rather unpleasant complications,00:19:43
but in any case,00:19:45
thank God, the fracture of the frag tour is not fatal.00:19:49
What do we know about the fracture? a violation of the00:19:52
integrity of the bone caused by physical00:19:55
force or a pathological process,00:19:57
there are two mechanisms for the occurrence of00:20:00
traumatic fractures: a direct00:20:02
mechanism and an indirect one; in a direct fracture, the00:20:06
point of application of force and the location of00:20:08
the injury coincides, that is, it is most00:20:12
often a blow aimed clearly at a00:20:14
specific bone and the traumatic00:20:17
change changes occur together with00:20:19
the fracture, as we can see very beautifully here, the00:20:22
fracture of the middle third of the diaphysis of the00:20:24
proximal phalanx of the fifth finger of the00:20:26
right hand is00:20:28
comminuted with a displacement of fragments along the00:20:31
width and minimal herniation,00:20:35
it is important to remember that colleagues, when we00:20:37
talk about such fractures,00:20:40
urgent immobilization is mandatory and often in00:20:44
some moments these fractures do not00:20:46
require reposition; indirect mechanism00:20:50
when the point of application of force and the place of00:20:52
injury do not coincide; the classic00:20:55
picture is a fracture of the surgical neck of the00:20:57
humerus00:20:59
when the patient falls on his outstretched arm and00:21:02
here the railing if at the same time00:21:05
he also experiences rotation00:21:07
of the limb, we see the simultaneous separation of the00:21:10
greater tubercle with the formation of which is necessary in00:21:14
such a situation, you are their00:21:16
most severe injury00:21:18
caused by the indirect mechanism of the00:21:21
applied force, what do we know about the00:21:27
types of fracture in relation to the plane00:21:30
of the fracture, there are transverse fractures,00:21:38
longitudinal obliques and00:21:41
oblique entry we have with divergence00:21:46
wedge-shaped fractures00:21:48
comminuted and so-called perforated00:21:52
fractures occupying only the cortical00:21:54
layer there are very, very many options, you00:21:57
and I just understand that these are the00:22:00
words with which the radiologist00:22:02
describes the fracture line when he00:22:05
sees it the most important thing in a competent description00:22:09
traumatic changes in the limb, this is the00:22:12
displacement of fragments precisely from the displacement of00:22:15
the fragments, just as natural00:22:17
shortening or00:22:20
lengthening of the limb depends on the fracture line; visual, that is, a00:22:23
displacement along the length of the00:22:25
divergence of the fragments at the origin; a00:22:29
displacement in width by the width of the diaphysis by00:22:33
one third of the width of the diaphysis; most often00:22:36
these terms are used in the description:00:22:39
displacement at an angle and here we00:22:42
try to write the angle of the open to the rear00:22:44
near the open I put it on the surface and00:22:47
so on, depending on the location of the00:22:49
fracture and fractures with displacement along the axis,00:22:53
rotational fractures when a00:22:56
twisting mechanism also occurs and we see a00:22:58
fracture of the femur that is00:23:00
practically00:23:01
uncontrollable by any means except for00:23:04
surgical ones, when the distal end of the00:23:06
injured bone is rotated almost00:23:09
90 degrees in relation00:23:12
to the proximal end of the bone, what should be00:23:16
remembered is that an injury is not just a broken00:23:18
bone, it is a traumatic disease, it is a00:23:21
whole symptom complex that occurs00:23:24
video of the body’s response to00:23:26
a fracture, and this is exactly the mechanism I00:23:30
would like now to discuss it a little with00:23:32
you because very often now00:23:37
there is a tendency again to extreme removal00:23:39
of mobilization, this is a sin quite often00:23:42
when they follow the lead of a patient who is00:23:45
tired of wearing a cast, asks for more00:23:47
mobility, says that he00:23:49
has torn everything, everything is fine, you should00:23:51
still remember that the first seven days00:23:52
after the fracture there is00:23:56
resorption of the end sections of the bone against the00:23:59
background of this resorption, then we see better the00:24:04
x-ray joint space of the fracture and00:24:06
if the radiologist writes the fracture is in00:24:09
question after five days I recommend00:24:11
repeating the image against the background of00:24:13
articular resorption ask the fracture line will be00:24:16
visible better the00:24:18
next 7 days callus00:24:21
connective tissue or these are00:24:23
deposits of fibrin in the hematoma then00:24:26
fibrous callus the next family00:24:28
example yes we are talking about de offices and00:24:31
finally callus00:24:34
fibrous callus can keep you from breaking00:24:37
if there is no pronounced muscle traction00:24:39
if there is it they won’t keep you from breaking you00:24:42
will get a secondary displacement based on00:24:45
this I strongly recommend that you monitor the00:24:47
moment when you remove the plaster;00:24:50
in this regard, a radiologist can also help your patient;00:24:55
complex fractures in need of00:24:58
surgical intervention00:24:59
are a global problem that00:25:02
humanity has faced many times00:25:05
because, as our great doctor00:25:08
and compatriot said, war is a00:25:10
traumatic epidemic during the period of00:25:13
wars, traumatology as and radiology00:25:15
took giant steps forward00:25:18
in00:25:20
pour lane proposed a plate for abutment00:25:23
synthesis of his own design and00:25:25
achieved only fragmentary compression, in00:25:28
fact this is the first acute synthesis which00:25:31
was successful00:25:32
Robert did not conclude that a00:25:35
fracture is an indication for surgery and he00:25:38
used the axis of your synthesis technique00:25:40
the creation of inter-fragmentary compression00:25:42
on the plate and for the first time described the morphology of00:25:45
direct bone fusion00:25:48
without the formation of callus, that is, and00:25:50
the rest of the bone formation, the00:25:56
wonderful phrase of George Perkins00:25:59
that most problems after a fracture are00:26:01
associated with treatment, they are with the00:26:03
pathology itself, and00:26:05
then00:26:08
in the mid-20s when Robert Danis00:26:11
was the most authoritative representative of the00:26:12
world traumatological community,00:26:14
he met with several young00:26:17
surgeons and, above all, with Marisa Miller,00:26:19
who was inspired by the ideas of his senior00:26:22
colleague and performed 58 operations of open00:26:25
reduction and stable internal00:26:27
fixation of fractures, carefully00:26:29
documented all cases and this began00:26:34
after that in a hotel in a small town in00:26:38
Switzerland on November 6th before the birthday of00:26:42
1958, a working group of 13 surgeons was created00:26:47
which began to seriously engage in the00:26:51
development of problems and acute synthesis of00:26:55
fractures00:26:58
by them and later by their colleagues, and00:27:01
until today00:27:03
proposals for modification of this00:27:05
classification have arisen, an alphanumeric00:27:08
encoding has arisen in which one humerus00:27:12
2 radius ulna 3 femur 400:27:17
tibia and so these are the numbers00:27:19
that we see then he comes to us00:27:22
under and with thick00:27:25
synthesis performed anywhere in the world 200:27:28
metaphyseal segments distal and00:27:31
proximal ankles these are exceptions00:27:34
metaphysis epiphysis adult patients are not00:27:37
distinguished, that is, we have a00:27:39
segmental bone structure,00:27:42
while the proximal and distal mid-00:27:45
epiphysis rn and segments are defined as a00:27:47
square, the side of which is the widest00:27:50
part of the epiphysis, we will now look at all this00:27:51
in the picture and the exceptions to the00:27:54
rules and squares are the00:27:56
proximal segment of the femur00:27:58
due to its anatomical features and the 4th00:28:01
segment of the lower leg of the ankle due to the fact that a00:28:04
fracture of the fibula can00:28:06
occur throughout the entire mountain, and so00:28:08
let's see, these are the very00:28:10
segments from the classification that you and00:28:15
I people look at, please, the00:28:17
humerus is number 1 and we divide it into00:28:21
segments 1 2 3 we got the numbers 11 1200:28:27
13 when we talk about the00:28:32
radius we don’t just have 200:28:35
22 and 23 before we insert the letter r radius00:28:41
latin latin00:28:43
then flax the same first number00:28:48
2 talking about what we have the thing with00:28:50
the forearm and the00:28:52
letter of the ulian is the same, we have three00:28:57
segments we need,00:29:00
division between the segments and so and drink from the00:29:03
metaphysis apophis three parts of the bone that00:29:05
should be remembered when healing a fracture in the00:29:08
diaphysis there is a cortical layer that has an00:29:11
outer and inner end00:29:13
plate and here is the periosteum active00:29:15
here occurs under the periosteum and00:29:17
hematomas are the most common injury of a football player,00:29:20
but here he wears shin guards and00:29:23
our children diligently play football00:29:26
on the playground near the school,00:29:28
as my daughter naturally also00:29:31
wears kitchens, so she comes with bruises on00:29:33
my front surface of the00:29:35
tibia and that’s it time00:29:38
complains that again and the boys00:29:39
hit the shin and it hurts, a blow to the00:29:42
periosteum is extremely painful00:29:44
active periosteum the periosteum00:29:46
growing in width and giving a pronounced00:29:49
bone callus is only in00:29:52
the geophysicist only there, therefore it is here that00:29:57
we see all the options from laminated00:29:59
periosteum as soon as the pathological00:30:01
process takes these squares,00:30:04
that is, everything that we have under numbers00:30:08
1 and numbers 3,00:30:13
as soon as we get into this00:30:16
zone that is unpleasant for us, here the active slope is prostrate and00:30:19
will never be, we will never see Perry,00:30:22
the rest of the bone formations, we see00:30:25
only endosteel bone formations00:30:27
arising inside the medullary00:30:29
channel, this is important to understand, so you and I00:30:32
have decided on the segments, everything is very00:30:35
simple here: femur 31 32 3300:30:39
shin number 4 in the fimor,00:30:44
yes we separate it separately 41 42 4300:30:50
at the moment there is nothing complicated00:30:53
the following in terms that we00:30:55
must remember in this classification00:30:57
because that this may sound in the description00:31:00
as a text part, a simple fracture, a00:31:03
fracture from one line in which the00:31:05
contact area between the fragments after reposition00:31:07
exceeds 90 percent; simple fractures00:31:10
can be screw-shaped, oblique00:31:12
transverse or close to them, and in00:31:15
this case we can clearly see a00:31:17
transverse fracture of the lower third of the diaphysis00:31:21
of the tibia in a child, we00:31:24
see that he has a metaphysis and cartilage, a00:31:27
fracture with the presence of a wedge or a wedge-shaped00:31:30
fracture, there may be three or00:31:33
more fragments in it, as in this case00:31:35
we have a splintered wedge after repositioning00:31:37
this fracture, the main fragments00:31:39
are in contact with each other then we00:31:41
must compare them00:31:43
and create compression; the wedge can be00:31:46
spiral or flexor,00:31:49
that is, when the wedge-shaped processes00:31:52
are located around the bone, the crater is00:31:55
essentially around it, or at the bend of the bone, a00:32:00
multicomminuted fracture can00:32:02
also contain several fragments, as00:32:05
in this case we see small00:32:07
fragments in a classic typical00:32:10
fracture of the radius of the00:32:12
radius with expressions of shiva displacement00:32:15
after reposition there will be no contact between the main00:32:18
fragments there will be too00:32:20
many fragments to accurately determine the00:32:22
anatomical location of the fracture00:32:24
it is necessary to determine its center if you00:32:27
and I cannot understand where the00:32:30
center of the fracture is, we will not tell00:32:32
the localization correctly drink from the metaphysis de office and00:32:35
what is this cortical zone or is it the00:32:37
central sections of the bone and so for a00:32:40
simple fracture the middle point of the oblique00:32:42
or spiral fracture line00:32:45
for fractures with the presence of a wedge is the00:32:48
widest part of the wedge or the middle00:32:51
point of the fragmented wedge after00:32:52
reposition to in this case this a00:32:55
nice smiley face shows us the00:32:57
central sections for complex fractures,00:33:00
the center is determined after reposition with00:33:03
restoration of the length of the bone as the middle00:33:05
between the proximal and distal00:33:08
boundaries of the fracture, here it is, a thin and00:33:10
delicate fracture line, an ideal00:33:12
comparison of fragments, here it00:33:14
ends, and here it is, the very00:33:17
middle of the fracture and when asked what is00:33:19
broken distal third proximal00:33:22
part or middle we can immediately00:33:24
tell you that this is a fracture at the border of the00:33:27
middle and distal third of the00:33:28
tibia with a fixed00:33:31
plate with screws00:33:34
Dmitry cafe zarns and fractures are a very00:33:36
complex group of fractures, first of all,00:33:38
that they pass through the articular00:33:40
surface, that is, intra-articular00:33:42
fractures are00:33:43
some of they are not complete, in which00:33:46
the articular surface remains00:33:47
intact00:33:48
and retains the connection of the diaphysis, or complete,00:33:51
in which the entire diameter of the00:33:54
metaphysis rnai part of the bone is damaged and, more often than not,00:33:56
fractures occur much more00:34:00
safely, and since we code00:34:03
the diagnosis, we code first of all which00:34:07
bone to 1 2 3 4 then we encode its00:34:10
segment 12300:34:12
sometimes a letter is added, in fact,00:34:16
everything is extremely simple, a great idea,00:34:22
then00:34:25
we encode the morphological picture of the00:34:29
fracture, what happened radiographically00:34:33
and again three types a b and c a simple00:34:37
fracture b wedge c multi-comminuted00:34:40
nothing complicated we have all this already you00:34:43
mentioned00:34:45
metaphysis type a, extra-articular fractures, type00:34:50
b, incomplete articular fractures, type c,00:34:54
complete articular fractures,00:34:57
every time we talk about00:35:00
metaphyseal fractures, we must understand with you that00:35:04
it is in these cases that00:35:07
magnetic resonance imaging comes to our aid, I00:35:10
will repeat again before the indicator of arteries and00:35:13
in general, magnetic resonance imaging, I00:35:15
fundamentally tried to maxim and00:35:17
remove the back and lectures, bringing it closer to the00:35:20
reality in which the majority of00:35:22
our patients live when it is possible00:35:24
to perform radiographs in a00:35:25
trauma center, at00:35:27
best, quickly gt00:35:30
to a prominent era has made its own adjustments00:35:34
to get and the pure selection of00:35:36
magnetic resonance imaging resonance tomography has become00:35:37
difficult, but it is necessary to remember an extra-00:35:40
articular fracture of the metaphysis of type A is00:35:43
perfectly visualized on an00:35:46
x-ray of the00:35:48
metaphysis; wounds and fractures of types b and c are00:35:52
obtained quite often; this is an overweight00:35:56
woman00:35:57
trying to either get off the stairs or00:36:00
jump from a vehicle while it is winter,00:36:05
icy, slippery shoes and now this00:36:09
jump, especially taking into account the excess weight,00:36:11
leads to severe traumatic00:36:14
consequences, including complete articular00:36:16
fractures and incomplete articular fractures,00:36:18
and another very important group of traumatic00:36:22
changes that require an MRI,00:36:24
often before this injury, received in the winter,00:36:28
this is an icy ice, this is a00:36:33
release, a prominent brain has forgotten the words what it is00:36:36
called, skateboard and melancholy no, neither a00:36:39
skateboard, a snowboard, this is a snowboard and this is00:36:42
alpine skiing, alas, the knee joint in these00:36:46
cases will be a necessary measure for00:36:49
diagnosis, this is the performance of00:36:51
magnetic resonance imaging,00:36:54
what exceptions do we know with you to these00:36:58
generally simple rules, these are00:37:02
complex joints, joints in which00:37:05
rotational movements are carried out,00:37:08
joints in which there is a very specific00:37:11
joint capsule in this case and this is outside the00:37:15
articular y non-focal fracture when00:37:18
we talk about the humerus yes the beautiful00:37:20
word proximal segment of the00:37:22
humerus is translated tritely yes as00:37:24
the head of the00:37:26
humerus00:37:29
b outside the articular by focal c00:37:32
intra-articular proximal segment of the00:37:35
femur this is the hip joint00:37:37
valve zone inside the capsular00:37:40
fracture of the neck and inside the capsular00:37:42
fracture of the head and segment of the ankle00:37:45
the most common injury by the way, it should be00:37:48
noted there is the same funny fact with the00:37:50
advent of fashion in the south, the number of00:37:53
fractures in the winter in northern00:37:56
countries such as00:37:57
Norway, Sweden and Denmark according to00:38:00
statistics has increased sharply00:38:02
because these shoes do not fix the00:38:05
ankle joint, they are too soft,00:38:09
which, by the way, positively highlights our felt00:38:12
boots, which have a fairly solid00:38:16
felt base and00:38:18
fix the00:38:20
ankle joint quite well, so when choosing00:38:22
shoes in winter for a child, you prefer felt00:38:24
boots but not Ugg boots, very patriotic,00:38:28
jokes, but in winter the best00:38:31
option is everything -the same shoes that00:38:33
fix the ankle joint for a long time and00:38:35
protect it from injury, especially00:38:39
when we have classic St. Petersburg00:38:41
ice, when under a layer of water there is00:38:44
such delicate ice that it is scary to00:38:47
walk on and so the ankles are divided into under the00:38:51
synthesis of fashionable through the synthesis of fashionable and above00:38:54
yourself, see find out departments of the00:38:56
humerus and so the main variant of00:39:00
injury to the humerus, we have already talked about this with00:39:02
you, is a fall on an outstretched00:39:04
arm, when we talk about children and00:39:09
fractures of the greater tubercle to00:39:12
isolated fractures of the00:39:14
greater tubercle,00:39:16
we must remember that the love of00:39:19
parents is limitless, the child walks along a00:39:22
log. slowly, daddy00:39:24
holds the hand, mommy holds the00:39:26
hand, the baby walks along a log, loses00:39:29
balance, starts to fall, and both00:39:31
parents with a sharp jerk tear his00:39:33
shoulder bones, then on both sides, most00:39:37
often in this case, dislocations and00:39:39
subluxations occur in the elbow joint, but alas,00:39:42
we have seen such children with a fracture of the00:39:45
greater tubercle of the humerus as a00:39:48
result of such specific00:39:50
love from the parents, well, what can I advise?00:39:52
Let it probably fall,00:39:54
but in any case, before the00:39:59
help of the girl should be adequate00:40:01
without traumatic consequences, what00:40:04
types of fractures in this area do we know?00:40:07
First of all, these are avulsion fractures of the00:40:10
tubercle00:40:13
this is a non-focal one, that is, one00:40:16
fracture zone with an extra articulation fracture,00:40:19
then a fracture of the surgical neck and a00:40:24
vertical fracture descending,00:40:26
perhaps even slightly below the thrower zone,00:40:29
these are options for group 1 of fractures and00:40:33
here we put a1 a2 a3 that is, how we00:40:39
classify it 11a00:40:42
111 a2 and 11a three resemble one00:40:48
humerus 1 proximal segment yes we00:40:52
named the bone we named the segment we00:40:54
named the type of fracture a and then named00:40:59
its location tuberosity00:41:02
surgical neck or vertical00:41:04
version of the fracture b extra articulation00:41:08
bifocal yes possible with formation00:41:11
dividing the fracture zone into three parts 1100:41:15
b1 y the tubercle comes off and00:41:19
traumatic changes occur with displacement, in00:41:21
fact, in the metaphysis zone, the area of the00:41:24
surgical neck00:41:27
11 b1 and, alas, the most severe fractures00:41:32
that are poorly treated since00:41:34
intra-articular ones almost always come00:41:36
from the grass of the rotator cuff, very severe,00:41:38
these are00:41:41
intra-articular or so-called 400:41:43
private fractures that occur through the00:41:45
anatomical neck with a rupture with a separation of the00:41:48
greater tubercle and the most severe00:41:51
variants of accompanying trauma to the00:41:54
metaphyseal zone 11 c3, excuse me, and00:42:00
so here is a00:42:03
text description of these fractures, we00:42:06
have an extra-articular fracture with a single00:42:09
bone fragment of the bone tubercle, this is an00:42:13
isolated fracture or a separation of the00:42:15
tubercle of the humerus, both with00:42:18
and without displacement displacement00:42:20
is treated00:42:22
safely, but remember, yes, this is a fracture00:42:26
that parents can arrange for their00:42:28
child outside the articular, a non-focal00:42:31
metaphyseal fracture with two00:42:33
fragments is a fracture of the surgical00:42:35
neck of the humerus, and finally down to00:42:39
the statutory non-focal metaphyseal00:42:40
fracture, vertical, divided into00:42:43
two fragments, this is a fracture of the surgical00:42:44
neck humerus and so let's00:42:48
see, it's the same one outside the articular00:42:51
at the non-focal isolated fracture of the00:42:52
greater tubercle of the humerus is00:42:55
perfectly visualized in this00:42:58
case there is a displacement with the passage of00:43:00
fragments, which tells us that such a00:43:03
dislocation of the greater tubercle in relation to the00:43:06
head with this specific step00:43:10
is not present no dislocation not subluxation downward statutory00:43:15
non-focal metaphyseal fracture with00:43:17
two fragments in the area of the00:43:18
surgical neck and00:43:20
finally type b most00:43:23
complex extra-articular by focal00:43:26
fracture of the proximal segment of the00:43:28
humerus with three fragments00:43:30
day the00:43:31
second fragment is the remains of the head and 300:43:36
fracture with severe displacement00:43:38
including the00:43:40
proximal section of the humerus00:43:44
between the fragments and00:43:47
finally c intra-articular fracture of the00:43:50
proximal segment of the humerus00:43:52
when we see four fragments00:43:55
c100:43:56
c300:43:58
when we also see the metaphysis rn and00:44:02
fractures please look at type c00:44:05
intra-articular fracture of the proximal00:44:08
segment of the humerus or fracture with00:44:11
four fragments00:44:12
look what we are here We see, most often,00:44:16
fractures of this kind are accompanied by00:44:19
dislocations, we see a separately lying00:44:22
fragment of the greater tubercle, we see a00:44:24
comminuted fracture of00:44:27
the head passing through the articular00:44:30
surface with the formation of bone00:44:32
fragments and a large number of fragments00:44:35
in the surrounding soft tissues of the limb, and00:44:44
I really don’t like the clearly expressed pain syndrome when the00:44:47
question is asked and what to do about this is decided by a00:44:51
traumatologist, a doctor who has access to both00:44:55
metal synthesis and synthesis, since00:44:57
adequate reposition of fragments, the00:44:59
radiologist can only00:45:01
state that in this case,00:45:03
type C, an intra-articular fracture of the00:45:06
humerus in combination with a metaphyseal00:45:08
fracture, we also have a metaphyseal fracture00:45:11
and a comminuted fracture of the head and a fracture of the00:45:13
greater tubercle and a pronounced displacement of00:45:16
all the fragments in the joint with a shortening of the00:45:19
limb by at least 5-6 centimeters00:45:24
diaphyseal segment of the shoulder when most00:45:27
often it became the country this sports00:45:30
injury is the injury of a skier unfortunately00:45:33
entangled in his ski racks this is a00:45:36
serious car accident and a huge00:45:40
number of reasons over the past two years,00:45:43
I have twice seen the00:45:45
consequences of attempts by00:45:47
urbanized comrades, quite00:45:50
urbanized,00:45:52
to independently climb them in rope00:45:56
parks, adults who absolutely00:45:59
inadequately use their00:46:01
safety ropes, as a result,00:46:03
a fall occurs and these are the kind of fractures00:46:06
that occur due to direct trauma when00:46:08
falling from a great height00:46:10
when the arms are straightened to the side and00:46:13
the person plans to hit a tree branch00:46:16
type A1 before we immediately say a simple fracture00:46:20
in this case we see a spiral line of00:46:23
fracture,00:46:25
also known as a rotational fracture oblique and00:46:29
transverse00:46:30
difference from the oblique and transverse line00:46:32
only in a degree greater than 30 degrees00:46:35
oblique fracture less than 30 degrees por the00:46:38
list is the00:46:40
following: a wedge, an00:46:42
intact wedge, when we see a00:46:45
wedge-shaped fragment without signs of a00:46:47
comminuted fracture, or this wedge is00:46:50
fragmented, that is, 12 b2 and 12 b300:46:55
and, alas, multi-fragmentary fractures with00:46:59
intact segments when the segment00:47:03
is broken but it has no signs of fragments in00:47:06
it, and there is a dislocation there can be00:47:09
absolutely any and second moment when00:47:12
all our segments are fragmented, a much00:47:15
worse option is injury, what will it00:47:18
look like please look at type a00:47:21
this is a simple fracture in this case with a00:47:24
displacement of one-half of the width and00:47:27
diaphysis this is a simple fracture00:47:31
transverse00:47:34
b a fracture with the presence of a wedge or00:47:38
wedge-shaped the fracture in this case,00:47:40
we have not just a wedge-shaped fracture, but00:47:42
we had severe displacement of00:47:45
fragments because the patient did00:47:47
not promptly seek medical help00:47:49
immediately after the fracture occurred,00:47:52
being in the stage of00:47:54
quite pronounced alcohol intoxication, he tried to00:47:57
move and use his00:48:00
injured limb, which led to00:48:02
massive the most difficult is the displacement in00:48:05
its width, such as a wedge, a00:48:09
multi-comminuted fracture,00:48:12
please look at a multi-comminuted fracture with a00:48:14
pronounced displacement of fragments as it00:48:16
moves, that is, a displacement in width at an00:48:19
angle with rotation and the formation of a large00:48:22
number of soft tissue fragments, if00:48:25
you look, we will see with you that the00:48:28
fracture line is still wedge-shaped,00:48:31
these are fragments of the wedge, the00:48:34
distal segment of the humerus is all the00:48:38
same as what we talked about00:48:41
when we talked about the humerus, but there we00:48:45
talked about a bad equal fracture, in fact,00:48:47
here are also auction fractures00:48:49
that arise from excess load and they00:48:52
can be aussi he her simple, the same00:48:56
transverse at an angle or with rotation, and00:49:01
finally a wedge-shaped fracture, here it is, fractures that00:49:07
partially pass through the articular00:49:10
surface,00:49:12
lateral and medial and frontal00:49:16
fractures when we see such a00:49:18
specific fracture line, and here it00:49:21
should be said that only00:49:25
doctors who adequately understand the situation - the radiologist00:49:28
will carry out research in this case in an00:49:30
adequately selected lateral projection;00:49:32
here it is extremely important to bring the damaged00:49:36
joint in the ring on the verge into the lateral00:49:39
projection; in this case, the sight should be00:49:41
just slightly above the condyle; we are dividing00:49:45
into this zone; the projection may be somewhat00:49:47
atypical; not quite familiar; and only in00:49:49
In this case, we will clearly see the frontal00:49:52
line of the fracture and finally a complete00:49:55
articular fracture and the so-called simple00:49:59
wedge-shaped and, alas, multi-fragmentary00:50:02
logic is the same, I repeat the same words all the time, the00:50:05
beauty of this00:50:08
classification is that for each00:50:10
fracture there is a clearly defined00:50:13
type of treatment00:50:15
extra-articular emulsion fracture in a00:50:18
child00:50:20
resulting in an adult00:50:22
resulting from absolutely00:50:25
inadequate physical activity attempts to00:50:28
learn to play tennis00:50:29
tennis in order to look very good well,00:50:31
anything happens in our00:50:35
lives, not a complete intra-articular fracture00:50:43
and, alas, gunshot fractures if they00:50:47
occur in the area of some joint they00:50:50
always become complete, many with the00:50:52
tips inside the articular fractures and,00:50:55
alas, the treatment here is extremely complex and00:50:59
can end for the patient arterial00:51:01
misfortune. I would like to remind you that there are two00:51:04
types of fractures that are always open;00:51:06
any fracture passing through the socket of a00:51:09
tooth in the jaw is an open00:51:11
fracture and any gunshot fracture00:51:14
is an open fracture; moreover,00:51:17
it is considered to be primary; the00:51:20
radial ulna and the bones of the00:51:22
forearm are infected, which we use most00:51:24
often and most often injure them, what00:51:27
should be remembered is the clinic fracture, we see00:51:31
deformation, we understand the pain syndrome00:51:34
in all cases except one fracture of the00:51:36
radial head bones in order to00:51:39
determine the presence of signs of this00:51:41
fracture, we ask the patient to perform a00:51:44
movement remember soup carried soup spilled00:51:46
pronation and supination when performing these00:51:49
movements pain occurs in the00:51:51
area of the head of the radius and00:51:54
allows us to decide something for me00:51:56
then at least which zone we should go to00:51:58
take aim and possibly supplement00:52:00
computed tomography with a regular00:52:02
x-ray and so we left00:52:06
bone number one and move on to the segment of00:52:10
bones number 2, these are the radius and00:52:13
ulna of the forearm and so on00:52:17
down the articular fractures,00:52:20
incomplete articular fractures and the floor and00:52:23
articular fractures in the first segment, that00:52:28
is, the proximal segment we are talking about the00:52:31
elbow area, and00:52:34
so essentially this is the elbow joint00:52:38
and the00:52:39
two bones included in it, the radius and the00:52:43
ulna, I want to remind you that in the knee00:52:45
joint the fibula bone is not included in the composition of the bones of00:52:47
this joint; it is formed by the00:52:49
tibia, and our elbow00:52:52
joint is the radius and ulna bones and00:52:55
here the same absolutely ironclad00:52:59
logic, in my opinion,00:53:02
tuberosity at the00:53:04
place of attachment of the biceps an00:53:08
avulsion fracture is possible when it00:53:11
occurs tennis children small children00:53:14
whose loving parents from the00:53:16
age of three let them play sports in00:53:19
which the child holds a heavy racket in his hand00:53:21
and swings it, alas, it should be00:53:24
remembered that until .00:53:27
ossification in a child is represented by00:53:29
cartilaginous tissue with a small point of00:53:31
ossification, the likelihood of injury is huge00:53:33
five years seven years with fully00:53:36
formed tuberosity for God's sake00:53:38
give me a lightweight racket, but this00:53:41
inadequate desire of the parent to raise a00:53:44
future tennis hero leads to the extreme00:53:46
formation of deforming arthrosis in the00:53:48
elbow joint or, in general, quite00:53:50
serious complications This is what we00:53:52
see quite often in children of00:53:55
loving parents who have sufficient00:53:58
finances for the child to play tennis00:54:00
seven days a week, the00:54:02
second option is a fracture of the neck, a simple00:54:05
fracture, a00:54:06
comminuted fracture,00:54:07
all the same, I remind you 2 this is the forearm segment,00:54:13
one is the proximal bone segment,00:54:18
then an00:54:20
extra articulated fracture and its type00:54:27
partially00:54:28
into a vessel partially intra-articular fracture00:54:32
simple and fragmentary everything is very simple00:54:36
and the00:54:37
last option is a fracture that completely passes00:54:40
through the line of traumatic changes00:54:42
is a fall on the elbow a fall from a00:54:46
great height the00:54:48
proximal segment of the ulna bone everything is the00:54:51
same, but a juvenile fracture or a00:54:54
fracture at the site of attachment of the00:54:57
triceps tendon and00:54:59
here again a very specific injury00:55:02
is the loving parents of the boys who00:55:05
force them to work out intensively in the gym to00:55:08
form a muscular corset and along the00:55:11
front wall of the chest and so that the00:55:14
boy has beautiful hands.00:55:17
Unfortunately, we have a00:55:20
certain group of parents who00:55:22
force their children to go to the00:55:24
agent’s gym seven times a week so that we go00:55:26
to you for a boy with obvious disorders of00:55:28
endocrine00:55:31
metabolism, then turn him into Superman, a00:55:34
very sad spectacle, it ends00:55:37
where the child is always bad, they say00:55:40
that the parents are evil, but00:55:42
often what the parents failed to do they00:55:45
try to embody in the children, and then00:55:47
these children came to we have a trauma00:55:49
in the Petrograd region, the00:55:51
next moment is a00:55:54
simple and00:55:57
simple metaphyseal and00:55:59
comminuted metaphyseal00:56:02
partially intra-articular fracture with a00:56:05
fracture of the olecranon process or with a00:56:08
fracture of the coronoid process and00:56:11
finally a completely00:56:13
intra-articular fracture when the00:56:16
islands of the coronoid process are broken, I remind you of the00:56:20
olecranon process of this very complex00:56:23
bone and let's look at a simple00:56:27
fracture of the neck of the radius, how to00:56:29
optimally look at it and where and in the best place00:56:31
to look, naturally it will be best to00:56:34
visualize the00:56:36
lateral projection, here it is the lower line of the00:56:38
fracture with a fairly small00:56:41
displacement00:56:48
incomplete articular fracture, let's00:56:50
see what it looks like and what we see at the same time00:56:53
we have a fracture of the head of00:56:57
the radial bone, pass through and the marginal one that00:57:01
passes through the joint capsule ask for00:57:04
it through the area of the articular surface00:57:07
and, alas, a complete articular fracture when00:57:10
we have a completely destroyed or faucet we00:57:13
have a violation of the integrity of the end00:57:16
plate of the coronoid process and a00:57:19
fracture of the radial head superimposed on it00:57:23
diaphyseal segment of the radius and00:57:26
here it’s very simple, yes everything is the same,00:57:29
shaped oblique and transverse00:57:32
fractures of the diaphysis of the arnova segment, second00:57:35
option b these are wedge-shaped fractures wedge00:57:39
intact wedge fragmented and00:57:41
then we have a comminuted00:57:43
fracture and how in00:57:46
time from breaking into slippers they00:57:49
fragmented we get used to the fact that00:57:54
everything is the same and00:57:56
so flax here we introduce the rubrication of the00:58:00
lion or the radius before the previous ones we had00:58:02
the radius now of the flax everything is the same00:58:07
no differences ul Norris and radialis00:58:10
have the same rubrications I00:58:14
remind you again we are talking about the number 2 this is the00:58:17
middle segment of a00:58:20
transverse fracture of the ulna with an00:58:22
angle of less than 30 degrees, excellent, the00:58:26
fracture line is visualized, a displacement00:58:29
by the thickness of the cortical layer and apparently00:58:32
good, such a powerful one under the periosteum and a00:58:34
hematoma that appears here a wedge-00:58:37
shaped fracture of the ulna with00:58:40
the formation of an intact wedge, here it is00:58:44
perfectly visible, we are clearly visible to you00:58:46
we visualize the00:58:48
absence of any holes in the00:58:50
area of the sphenoid fractures of the distal00:58:53
segment of the radius, you are all the same here,00:59:00
we have come to number 3 and00:59:05
again the most common injury in the city of00:59:07
St. Petersburg is a fracture in an hour, a00:59:11
typical place is our favorite winter00:59:13
injury is not sprinkled sand path and, in00:59:16
general, when we are heroically trying at any00:59:19
cost to get to our native university, in our00:59:22
case, from the Petrogradskaya metro station,00:59:25
so00:59:29
these are geese, he is her fracture of the styloid00:59:33
process, a bunch00:59:36
further, we have what else could we have, we00:59:40
could have a simple fracture, we could00:59:44
have multi fragmentary fracture00:59:45
wedge fracture and what else should be00:59:49
remembered when we talk about a completely00:59:52
intra-articular fracture00:59:56
it can be multi-fragmentary it01:00:00
can be internally articulated to01:00:02
intraarticular and it can involve the metaphyseal area01:00:09
let's see I'm sorry here01:00:12
I have a mistake it's written here radial the01:00:14
ulna, yes, here is where it01:00:17
went, the radius, everything is correct,01:00:20
I wanted to show you,01:00:23
look now, one second, I’ll be back01:00:26
on the radiographs, I lost mengin01:00:29
gram, the01:00:34
distal segment of the ulna,01:00:37
everything is simpler here, the previous radial bone is the01:00:40
ulna, yes, the same thing, the styloid process, a01:00:44
simple fracture, a multi-fragmentary01:00:47
fracture partially inside articulated and01:00:50
completely ocular fracture01:00:53
complex joint returning back01:00:57
distal segment of the radius01:01:00
styloid process01:01:03
simple transverse fracture and01:01:06
wedge-shaped fracture this is a heading a01:01:12
partially passing through the articular01:01:15
surface fracture types b yes this is a01:01:19
Barton's fracture or a reverse transition of the01:01:22
bead to the01:01:24
following groups of01:01:26
fractures this is a passing fracture through the01:01:29
articular surface why am01:01:31
I focusing on this particular group of01:01:33
fractures what are we talking about, but here is the01:01:37
very slide that I was looking for and which are01:01:38
not available, I sprayed, excuse me,01:01:41
extra-articular and intra-articular fractures01:01:43
in this area there is a small feature that01:01:47
can be clearly seen when we see an01:01:51
increase in the distance between the01:01:54
radial and ulna bones, that is, we01:01:57
see a rupture of the membrane interface, I01:01:59
almost always these fractures will01:02:02
pass through the articular surface,01:02:06
small, it seems like such a small01:02:09
little feature, it really helps the01:02:10
radiologist in his work, what we01:02:13
should remember is a01:02:14
non-articular fracture of the distal01:02:17
metaphysis of the radius, simple in this01:02:20
case without displacement fragments from the scrap in the01:02:23
same case we have about Waltz he is her01:02:26
fracture of the styloid process of the ulna01:02:30
not a complete articular fracture of the distal01:02:33
mid and epiphysis of the radius and01:02:38
please look carefully we have a01:02:40
complete intra-articular fracture of the01:02:44
distal segment of the ulna what is01:02:47
important to see here please look at the01:02:49
dislocation of the ulna of the bone,01:02:52
it moves more distally visually01:02:55
due to changes01:02:59
in both the calinin and the angular displacement of01:03:03
fragments of the radius, and we see01:03:06
this specific dislocation of01:03:09
all the bones of the hand towards the01:03:13
radius. In this case,01:03:15
the membrane always ruptures and this is what I just01:03:17
talked about. only we see something similar,01:03:20
we always have a fracture passing through01:03:24
the joint, which means it will take longer to heal due to01:03:27
dusty bone formation01:03:29
than a fracture of the diaphysis, and here it is easier for01:03:33
displacement to develop, and it is precisely in these01:03:35
cases of these fractures that01:03:38
the plaster cannot be removed prematurely; a complete01:03:40
articular fracture of the distal metaphysis cannot be removed01:03:42
radial bone and01:03:44
comminuted simple or on the gas tip and01:03:47
fracture in this case, again, we have01:03:49
total destruction of the articular01:03:51
surface due to a fracture on the gas01:03:53
annular we have a01:03:55
separation of the01:03:57
olecranon process and displacement of fragments as01:04:01
old radiologists are used to saying01:04:03
the hand has deviated here the corner of the postcard to the01:04:05
rear of the hand deviated here the angle is open01:04:08
palmar side the01:04:10
next bone is infinitely beloved but also the01:04:13
hip joint01:04:15
proximal segment of the femur01:04:18
bone number three proximal segment01:04:22
number 1 and01:04:24
then all the same01:04:30
look please01:04:32
we see a simple avulsion fracture yes the so-01:04:36
called before rajon tar fracture01:04:40
where we have it separation [ __ ] antara it is01:04:44
difficult to achieve such beautiful lines but01:04:46
this is also possible01:04:49
world trochanter multi fragmentary fracture01:04:52
yes when we see01:04:55
predominant traumatic01:04:58
changes and the distances between the01:05:00
fracture lines on the lateral surface01:05:02
more than 20 millimeters long and what is01:05:07
called a bear fracture01:05:11
then when we talk about the heads again01:05:15
three fracture lines soup captain soup01:05:18
capital01:05:20
transverse and base circulatory line01:05:25
finally, alas, ready for the bone itself and here01:05:29
we can see both01:05:31
depressed fractures01:05:33
and a rebound avulsion fracture,01:05:36
splitting of the bone, and so a fracture of the01:05:39
virtual zone, the neck of the femur,01:05:41
a fracture of the head a b and c and here here we01:05:46
are talking about an isolated trochanteric fracture01:05:49
2 fragmentary fracture when at a01:05:51
distance of one and a half lines the surface01:05:53
we will have, yes, this is the very two01:05:55
centimeters fracture with an intact wall, a01:05:57
fracture of the valve zone and other01:06:01
options, I’ll allow myself not to voice them anymore,01:06:03
but let’s better see what01:06:06
we can see in of our patient, I want to01:06:09
draw your attention to this, near the01:06:11
cable in the pelvic cavity, these are tablets01:06:15
that were consumed in large quantities by the01:06:19
patient in01:06:21
astronomical quantities, they are still01:06:24
here and the painkiller and most importantly,01:06:27
immediately after the fracture, the patient took 2501:06:30
calcium tablets, which is very helpful in the01:06:33
healing of valve fractures zones01:06:36
comminuted with damage to the lateral01:06:38
wall01:06:40
fracture of the femoral neck soup01:06:43
major wedding with on imp shares without01:06:45
displacement with displacement of fragments and fracture of the01:06:49
femoral neck trances for centuries01:06:51
let's see what it will01:06:52
look like here is a classic soup01:06:55
major fracture of the femoral neck that is01:06:58
why our grandmothers suffer and01:07:01
approximately exactly this fracture was the01:07:04
cause of one of the diagnostic errors01:07:05
made by one of the most experienced and01:07:08
beloved radiologists who01:07:11
carefully01:07:12
analyzed the01:07:15
results of the patient’s computed tomography scan; the01:07:17
scanning area was the01:07:19
hip joints; the patient01:07:21
complained of pain in the lower back and01:07:24
spine and at the same time01:07:27
moved briskly despite attempts to do01:07:29
everything possible. still a map to help yourself when walking, a01:07:32
fracture of the neck of the femur, the soup is01:07:34
capitally knocked together, and01:07:37
when the grandmother was asked to tear off the heel01:07:40
while lying on the bed, she did not do it.01:07:44
Here again we are faced with the fact that01:07:46
the clinic must also competently and adequately01:07:50
evaluate the transcervical fracture of the01:07:52
femur and move on to the final01:07:56
segment that we know everything about it is the01:07:58
same and such number three segment number01:08:03
two a simple fracture the same angles and01:08:08
transverse line of fracture angle more than 3001:08:11
percent angle less than 30 percent01:08:15
wedge-shaped fracture yes with the presence of a01:08:18
wedge-shaped fragment01:08:20
intact calendar intact wedge and01:08:23
fragmentary fragmented wedge01:08:26
here everything is the same as in the diaphysis of01:08:30
other tubular bones for the femur01:08:33
there are various categories,01:08:35
again we will not dwell on this01:08:37
actively, I just want to01:08:40
remind you that a fracture of the femur01:08:43
is most often a severe car01:08:45
injury accompanied by injuries to other01:08:48
organs and systems,01:08:50
what else one should remember massive01:08:53
fractures of the femur comminuted01:08:55
severe fractures can be accompanied by01:08:58
fat embolism, this should also be remembered01:09:00
and the development in this group of patients of01:09:02
manifestations of thromboembolism of the branches of the pulmonary01:09:04
artery is an extremely unfavorable01:09:07
sign of the course and again my favorite01:09:10
term of traumatic disease the01:09:14
next moment patients with trauma in01:09:16
this area is quite long time01:09:18
they can remain motionless in bed01:09:21
and again this is a group of patients femoral neck01:09:24
femur they will01:09:27
require careful monitoring of01:09:29
blood clotting and carefully01:09:32
try to avoid bedsores because those that01:09:34
arise after this are acute or you are01:09:36
neglected absolutely useless01:09:39
poor elderly patients01:09:40
living alone are quite serious01:09:44
complications leading to severe01:09:46
death, and so a simple transverse fracture of the01:09:49
femur with displacement of fragments along the01:09:52
width due to walking, the01:09:54
distal segment of the femur is a very01:09:57
interesting zone01:10:00
that we are used to looking at when we01:10:03
talk about injury to the knee joint, this01:10:06
zone that we can look at both01:10:09
magnetic resonance01:10:10
imaging and again we highlight, as in01:10:13
any proximal and distal01:10:14
segment of the bone, and maybe even its fractures are01:10:18
simple wedge-shaped or multi-01:10:20
fragmentary when we talk about extra01:10:24
articular extra-articular fractures extra01:10:27
articular rn and fractures01:10:29
partially intra-articular fractures01:10:31
that pass through the lateral01:10:34
limited we are snares and finally01:10:36
frontal fractures that01:10:39
completely pass through the articular01:10:41
surface; fractures are very severe in01:10:44
some cases even requiring the01:10:46
implantation of prostheses in this area,01:10:48
especially if they occur as a01:10:51
result of a bumper fracture. I would like to01:10:54
remind you that a bumper fracture is a01:10:55
traumatic change that occurs01:10:57
as a result of a car injury to01:10:59
pedestrians passing by a car behind01:11:03
over the past four months I have seen 801:11:06
fractures of the knee joint as01:11:09
a result of a collision between a pedestrian and a01:11:11
passing scooter, but as it01:11:15
turns out, it’s not just past, but over this01:11:17
very unfortunate pedestrian that the01:11:20
occupant of the scooter is passing by, alas,01:11:23
now in St. Petersburg this is becoming01:11:25
more and more popular injury and01:11:28
this should also be remembered,01:11:37
the classification sounds quite complicated, but the same thing follows,01:11:39
but we’re just generalizing: an extra-articular01:11:42
fracture, an incomplete01:11:44
intra-articular fracture, and a complete01:11:47
intra-articular fracture of the distal01:11:50
metaphysis of the femur,01:11:51
and look what a01:11:55
bad version of the fracture would look like,01:11:58
yes, this is a complete intra-articular fracture, a01:12:00
comminuted leg and01:12:02
there is no epiphyseal look at what01:12:05
happened to the articular surface and, alas, a01:12:07
large number of free bone fragments01:12:10
are visualized01:12:13
in the projection of the X-ray joint space, a01:12:16
very bad option and, alas, the displacement is01:12:20
very pronounced here, the displacement will be01:12:22
shortening the limb by almost01:12:25
10-12 centimeters, this is a much01:12:29
proximal segment of the tibia01:12:34
bone infinitely loved by students and01:12:37
teachers and very easy01:12:39
to draw and this is where we01:12:42
will most often see this very01:12:44
specific cortical trailing01:12:47
cortical layer and thin trailing01:12:49
plate01:12:51
at one time I saw a01:12:54
drawing of the tibia I had made posted on the Internet01:12:57
and fell into depression01:12:59
that and how in life I won’t learn to draw so01:13:02
that students don’t mock me later,01:13:04
but then I was consoled because01:13:06
they still had a test ahead of them, and the01:13:08
student’s life is entirely in the hands of01:13:11
his teacher at certain moments,01:13:12
for example, tests in a session, and so let’s01:13:17
see we will all be dealing here,01:13:20
nothing new,01:13:22
the classification is good in that it is01:13:24
standardized and so number 4 reflects01:13:29
what we are talking about the bones of the leg, number01:13:33
1 is the proximal segment and01:13:36
this means that we are talking about extra-01:13:41
articular situations, extra-articular fracture01:13:44
awol sion and simple or wedge-shaped, but01:13:49
all this happens outside the area of attachment of the01:13:52
joint capsule,01:13:54
partially intra-articular fractures, and01:13:58
here we should talk about what is01:14:01
called contusion fractures in01:14:04
Russian when a01:14:06
contusion injury occurs, here the place for01:14:10
diagnosis goes exclusively to01:14:14
magnetic resonance imaging01:14:16
compression of the end plate with01:14:19
perifocal bone edema of the brain, a01:14:22
radiologist can skip this option for a fracture01:14:25
when it occurs a jump from a01:14:29
great height, a jump from a vehicle onto a01:14:32
slippery road, especially if the01:14:35
patient at this time and also in Iraq has a01:14:38
leg, a01:14:41
bad option for a fracture and even worse01:14:44
when, against the background of a zone of contusion01:14:47
changes, we have our patient we see the01:14:50
fracture line, but we01:14:52
’ll talk about this a little more towards the end of our01:14:55
lecture with you, a01:14:56
completely intra-articular fracture, what01:14:59
is worth knowing about this here the situation is like this,01:15:03
firstly, this patient cannot stand on his leg,01:15:06
he screams in pain and the diagnosis01:15:10
in this case is01:15:13
radiological and the traumatological01:15:15
examination does not raise the slightest01:15:18
doubt, and01:15:20
so we repeat again, we are talking about a downward articular01:15:24
fracture, an incomplete intra-01:15:26
articular fracture, and from a clone, an intra-01:15:29
articular fracture, we lose the right once again,01:15:33
this may be emulsion changes in the01:15:35
metaphyseal simple and metaphyseal rnai01:15:38
wedge-shaped period and let's01:15:40
look at the classic the option is01:15:43
very nice, the most delicate01:15:47
fracture line is hard to see, you need to01:15:49
look carefully to see its course, here01:15:53
it is outside the articular metaphyseal simple01:15:56
fracture,01:15:58
incomplete intra-articular fracture, it can01:16:02
be with pure splitting, pure under01:16:05
pressure, or splitting with01:16:08
pressure,01:16:09
look how it looks01:16:12
x-ray, we see01:16:15
under pressure, here it and the fracture line01:16:21
splitting the01:16:23
articular surface of the01:16:25
tibia and a01:16:28
complete intra-articular fracture simple01:16:31
metaphyseal wedge-shaped or01:16:34
multi-compartmental and again complete01:16:37
intra-articular comminuted this injury01:16:40
requires hospitalization and careful01:16:43
selection of treatment diaphyseal segment and01:16:46
again everything is primitive to the extreme01:16:49
spiral oblique transverse fracture and with01:16:53
the formation of a wedge and tape of this and an01:16:56
intact wedge and finally a multi01:16:59
fragmentary wedge or decorate and01:17:02
wash and a fragmentary multi-az ringed01:17:05
fragment or a fragment without any01:17:09
changes to an intact segmental01:17:13
fragment again we will not repeat all this01:17:16
we will take care of our time01:17:18
because we still have a lot of interesting things,01:17:20
look at this classification, here it is a01:17:23
simple oblique fracture of the01:17:25
tibia, almost always01:17:28
accompanied by a fracture of the fibula, the01:17:31
distal segment of the tibia,01:17:34
what we see here, everything is the same,01:17:37
only the number k by 3 to the01:17:41
distal segment01:17:42
outside the articular, partial articular and01:17:46
completely passing through the joint area01:17:50
we are accustomed to another term, we are01:17:53
accustomed to a fracture of the outer and01:17:55
inner malleolus, before for us this is a more01:17:57
familiar terminology: a fracture of the outer01:18:00
malleolus with or without displacement, a fracture of the01:18:03
inner malleolus, or the so-called01:18:05
3 frets personal fracture when the01:18:07
posterior edge of the tibia is also broken01:18:09
most often In conclusion of the Russian01:18:11
rhythms and lags, we carry out these descriptions and, in01:18:13
general, we are all satisfied; however,01:18:15
again, this classification is01:18:18
accepted in different countries and which01:18:20
very often our colleagues, thanks to the01:18:23
efforts of Professor Belenky, began to01:18:25
write down conclusions and to my surprise01:18:28
I discovered this in a patient who01:18:31
I was leaving one of the hospitals in the city,01:18:34
brilliant, the descriptions described by the radiology doctor01:18:36
and then a decoding according to the01:18:39
classification and even this is generally01:18:41
remarkable, why not that one very well,01:18:45
so the extra-articular01:18:47
fracture is01:18:50
wedge-shaped with the formation of a wedge, here it is01:18:53
quite small and so on, not a01:18:59
complete intra-articular fracture incomplete01:19:03
intra-articular fracture with splitting and01:19:05
under pressure of the articular surface and01:19:07
here this specific group of patients,01:19:12
both01:19:14
43 b2 and unfortunately group C with01:19:19
intra-articular fractures, this is also01:19:23
specific to the city of St. Petersburg in its01:19:26
central regions when the second floor01:19:29
is quite high spring month01:19:32
my bright emotions and an unexpectedly01:19:35
appearing spouse leads to the fact that01:19:38
residents of St. Petersburg are still01:19:40
jumping from the windows of their beloved women onto the01:19:43
asphalt,01:19:44
landing on their heels and breaking01:19:48
bones in the joint in our feet,01:19:52
most often this will be accompanied by a01:19:54
fracture of the calcaneus,01:19:56
alas, this is a sad story that01:20:00
requires in general -the control of01:20:03
specialists over this group of patients,01:20:06
since often they are still found,01:20:09
it may be injuries to other parts of the01:20:11
skeleton of the01:20:12
ankles, this is an interesting area and as you01:20:17
see here everything directly depends on the01:20:20
synthesis of the muse01:20:24
isolated injuries to the01:20:27
fibula before damage to the fibula01:20:30
and we are talking about damage to the ankle01:20:34
of the tibia and01:20:39
with what is also called 301:20:42
ankle-brachial01:20:44
trans synthesis fashionable fractures and01:20:47
suprastin are possible, that is, above the zone of01:20:50
synthesis fashion of the01:20:52
ankles and the segment is also the painting segment of the01:20:55
ankle under the synthesis of the fashionable through the synthesis of the01:20:59
fashionable over Sidney controversial yes a b and c pan01:21:03
cindy complex fractures can be01:21:05
isolated can you with a fracture of the01:21:07
medial malleolus and with a dose of a medial01:21:10
fracture of the tibia here they are01:21:13
under synthesis fashionable fractures are01:21:15
isolated01:21:17
he himself a smeared fracture of the01:21:20
fibula with a dose of a medial fracture01:21:22
of the tibia then here it is that same01:21:24
trick of the ankles and the fracture when we see an01:21:27
injury to the posterior part of the epiphysis01:21:31
through the synthesis of a fashionable fracture of the01:21:33
fibula they will be01:21:36
visualized higher more often they have a screw in01:21:38
reverse motion they more often have a zone of01:21:40
displacement yes please look here it is with01:21:45
damage to the deltoid ligament by a01:21:47
fracture of the posterior edge of the tibia01:21:51
here it is a fracture of the projection of the fibula01:21:54
it goes away quite high and01:21:57
there are eleven unattended fractures that01:22:00
are located above this entire apparatus and01:22:03
here we visualize a complex fracture above Cindy,01:22:07
again an upward fracture of the01:22:10
fibula,01:22:12
fibula 4f fibula, all the01:22:18
same thing that01:22:19
should be remembered by the presence of leg01:22:21
comminuted fractures and pain, and in this01:22:23
case another excellent illustration of01:22:26
traumatic changes that arose after the01:22:28
use of firearms01:22:31
on gas conchita, such fractures01:22:34
require a mandatory antibiotic01:22:37
because this, unfortunately, is always an open01:22:41
fracture and infection of this thick01:22:43
grinds and so additional01:22:47
classification possibilities are universal01:22:49
modifiers, that is, words that can be01:22:52
added and numbers that will be their01:22:55
designate without displacement with displacement01:22:58
depressed along the action01:23:00
articular surface of the metaphysis rnai01:23:02
bezant actions dislocation anterior posterior01:23:06
medial and lateral lower01:23:07
multidirectional in addition number 6 in01:23:11
two instability of the ligamentous apparatus01:23:14
then 7 expansion01:23:18
8 will already touch the articular cartilage01:23:23
9 poor bone quality osteoporosis01:23:26
replantation01:23:27
amputation of01:23:29
nail art plastic implant fracture01:23:32
spiral type fracture flexor nova01:23:34
type these are01:23:36
additional words and additional01:23:39
rubricators that should be remembered there is the01:23:43
concept of qualifying cathars these are01:23:46
morphological terms specific to each01:23:48
fracture they have the right to01:23:52
use or not to use01:23:54
they are written in capital letters can01:23:57
be added at the very end so in01:24:01
order a binary guest is suggested to work correctly with this01:24:03
system01:24:05
when the doctor answers questions yes or01:24:09
no 1 and 2 immediately put a number and so01:24:14
which bone we put noah which segment01:24:17
we put the number what type of fracture simple01:24:21
wedge-shaped on gas finished put the number01:24:23
group if the fracture is simple group if the01:24:26
fracture is wedge-shaped groups if the fracture of01:24:29
the leg is comminuted then already qualify01:24:31
catarrhs and modifiers01:24:34
yes, look, it’s quite simple and01:24:38
convenient and the event is actually not bad at all to have such01:24:42
a sign01:24:43
on your01:24:47
desk that the only thing I would like to01:24:51
add is out learn by heart it is not necessary in01:24:54
any case it can be hung over at the table, you01:24:57
can put it under glass if you01:24:59
work every day, learn it01:25:01
automatically I am periodically distracted from the01:25:03
osteoarticular apparatus in connection with01:25:05
work, I can honestly say that01:25:07
I don’t remember it by heart, but if I go to01:25:11
the trauma department or I move01:25:14
closer to the trauma department of01:25:15
the university01:25:17
because that in a week I will be01:25:19
putting all these numbers completely01:25:21
automatically,01:25:23
and here is a wonderful phrase from our01:25:27
national manual: the diagnosis should01:25:29
be constructed in such a way that01:25:31
treatment tactics follow from it, starting01:25:33
from the preoperative planning period,01:25:36
rehabilitation and everything01:25:39
else, and here are a few words about01:25:42
magnetic resonance tomography when we01:25:44
can use it01:25:46
naturally, these are early manifestations of01:25:48
contusion fractures,01:25:51
bone marrow edema, it is possible to01:25:53
visualize even the fracture line and look, the01:25:58
computed tomogram shows us the01:26:00
fracture line passing through the01:26:02
articular surface and how wonderfully01:26:04
we see these changes in01:26:06
magnetic resonance01:26:07
imaging of our patient sincerely01:26:11
I thank01:26:13
my wonderful co-authors and friends for their help in preparing the lecture, to01:26:16
my colleagues in the department and colleagues at01:26:19
the university and at the city hospital,01:26:22
however, I would also like to talk about01:26:25
a few aspects that perhaps01:26:28
I did not emphasize enough. The first thing to01:26:32
remember is the01:26:34
classifications that01:26:37
I introduced him to today, she conveniently01:26:40
once again, in Korea and there is no need to learn by heart01:26:43
during constant work, please01:26:45
ask under the table for a photo with glass on the table before,01:26:49
or it may be hanging somewhere behind each01:26:52
fracture, there is a living person and we01:26:54
must be able to evaluate the01:26:56
remaining parts of the bone, the presence of01:26:59
osteoporosis, additional foreign01:27:02
shadows in the soft tissues everything that01:27:05
happens to the patient must be assessed with an01:27:07
X-ray, without any01:27:10
options, the radiologist is obliged to01:27:12
describe the calcified vessels, if in the01:27:15
fracture zone we see calcified01:27:18
vessels, this is a trophic disorder, a disturbance in the01:27:21
nutrition of the bone, this disturbance is possible in the01:27:25
functioning of the parathyroid glands and all these01:27:28
factors will influence healing of01:27:31
fractures,01:27:33
what else should be seen? a01:27:36
hematoma if it is under the01:27:38
periosteum, we have already talked about seeing a01:27:42
similar option, the radiologist is obliged to01:27:45
describe the volume of soft01:27:47
tissue swelling because otherwise this01:27:51
may be an underestimated factor, and the01:27:55
patient will have a plaster cast, which01:27:58
the doctor has the right to write - The radiologist to the patient01:28:01
after applying a plaster splint, in01:28:04
no case should the description be01:28:07
made in a plaster splint, there should not01:28:10
be a description of the rest or he01:28:12
will give a real bone formation01:28:14
to determine that it is a forming01:28:16
bone callus or is it an applied plaster of01:28:19
different thicknesses, it is almost impossible,01:28:22
this is a 100% diagnostic error,01:28:26
we can assess the displacement of fragments in the plaster01:28:30
but assess the severity of the01:28:33
callus, I highly recommend not performing01:28:36
this procedure, this is a mistake that can01:28:40
lead to a very serious complication for the01:28:41
patient, what else should the01:28:44
radiologist write in addition to soft tissues01:28:48
and the presence of a plaster splint dislocation and01:28:51
subluxation of adjacent joints01:28:54
fracture fracture but when taking an01:28:56
x-ray, correctly carry out01:28:59
the study by capturing optimally 201:29:02
joints, up to01:29:04
distal and proximal in01:29:06
relation to the fracture zone,01:29:08
but at least one joint is required to01:29:13
understand what is happening and the last01:29:16
moment we describe the displacement along the01:29:19
distal one from the fracture, we say that it is displaced01:29:23
and drink from in relation to diaphysis and01:29:28
the funniest thing is how a radiologist01:29:31
puts a picture on the screen, it’s extremely rare for a01:29:34
radiologist to put a picture down01:29:37
with his fingers if it’s a hand, you’re used to the01:29:39
standard position in it, it’s more convenient01:29:42
to watch, it’s more generally accepted, and01:29:45
again, returning to the cinema not so01:29:48
long ago, I had great pleasure01:29:50
watching the amazing a film from the life of01:29:53
doctors where all the radiographs that01:29:55
were placed on the screen were placed clearly01:29:59
upside down, head at the bottom, shoulder girdle01:30:03
at the top, and after that the doctors in the department01:30:06
went on a round so that you and I would01:30:08
never stand upside down and remember that there is01:30:11
not a single radiologist in the field a warrior is like a01:30:14
lonely beacon he has colleagues,01:30:15
traumatologists, he has colleagues, a01:30:18
general practitioner, and through joint efforts we01:30:20
can do a lot thank you for your01:30:22
attention, I’m done01:30:25
[music]01:30:34
dimexide gel is a modern form of a01:30:37
proven medicinal product with an01:30:39
analgesic and anti-inflammatory01:30:41
effect, now in a new package01:30:44
dimexide gel used in complex01:30:47
therapy of arthritis and arthrosis,01:30:49
radiculitis, thrombophlebitis, bruises and01:30:52
sprains,01:30:53
dimexide gel penetrates deeply and quickly01:30:57
into tissues and increases the permeability of the skin01:30:59
to other medications;01:31:01
enhances and accelerates the action of external01:31:04
forms of non-steroidal anti-inflammatory01:31:07
drugs heparin and venotonics;01:31:09
low toxicity; has no side01:31:12
effects on the gastrointestinal system tract01:31:15
is a safe alternative to NSAIDs in01:31:18
patients with chronic kidney disease and01:31:21
diseases of the gastrointestinal tract01:31:23
dimexide gel quick relief for pain and01:31:27
inflammation01:31:28
[music]01:31:30
well-proven sildenafil is01:31:33
now in spray format 12 and a half01:31:36
milligrams of the active substance in01:31:39
one press,01:31:40
effective within 10 minutes01:31:43
unprecedented flexible stasera vaniya01:31:47
james new format new possibilities01:31:55
panic attack sudden01:31:57
anxiety attack with vivid vegetative01:31:58
symptoms repeated panic01:32:00
episodes cause suffering to patients01:32:02
leading to escaping behavior and01:32:04
social maladaptation sees roxa01:32:06
is used as a symptomatic01:32:07
remedy for panic attacks01:32:09
somatoform autonomic dysfunction of the01:32:11
sympathoadrenal type active01:32:13
substance sees roxa prophet san01:32:14
belongs to the class of alpha-adrenergic blockers01:32:17
prophet san reduces the excitability dance bottlenose01:32:19
dolphins of brain structures regulates the tone of the01:32:21
sympathoadrenal system01:32:23
sees rox effectively stops01:32:25
panic attacks does not have a01:32:27
psychotropic effect does not cause01:32:29
drowsiness and addiction in the form of drugs01:32:31
first aid for panic attacksDescription:
Видеозапись онлайн-семинара "Лучевая диагностика травматических изменений костно-суставного аппарата" Дата проведения: 22.09.21 в 20:00 мск Организатор: https://obrfm.ru/ Докладчик: Ольга Васильевна Лукина Доцент кафедры рентгенологии и радиационной медицины с рентгенологическим и радиологическим отделениями, руководитель научно- клинического центра лучевой диагностики Первого Санкт-Петербургского медицинского университета им. акад. И.П. Павлова, доктор медицинских наук, доцент О семинаре: Лучевые методы играют ведущую роль в диагностике и выборе способа лечения скелетной травмы. В ходе онлайн-семинара будут рассмотрены современная классификация повреждений скелета, основные лучевые признаки травматических изменений, показания для применения разных методик лучевого исследования при травмах костно-суставного аппарата.
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