쉐도잉 연습: General principles of ortho trauma for PA students 1 - basics - YouTube로 영어 말하기 배우기

General Principles of Orthopedic Trauma.

⏸ 일시 정지

재생 속도:

189 문장

문장이 너무 짧거나 길면 Edit를 눌러 조정하세요.

General Principles of Orthopedic Trauma.

This is for the Lewis Kapp School of Medicine Physician Assistant Program.

I'm Saki Brahman.

These are my financial and related disclosures.

And some of the images were borrowed from the AO Foundation.

So these are the lecture objectives.

Number one, to understand the assessment and basic management of fractures.

to understand why some fractures do not heal,

to understand the complications and associated injuries that present with fractures,

and to understand some very basic principles of pediatric fractures and how they differ.

So, what is orthopedic trauma?

Well, it's a field that deals with the management of fractures and related injuries.

It often deals with hospitalized patients,

perhaps a little more so than some of the other orthopedic disciplines.

It includes operative and non-operative care to help patients return to function after injury.

So these are some of the topics I'd like you to know after this lecture and our live session.

extremity and pelvic fractures, associated neurovascular injury,

pathologic fractures, osteoporosis, fracture non-unions,

splinting and casting principles, and this will be reinforced in a workshop,

and basic surgical fixation principles,

just real basic simple stuff.

Now, there are some related topics that will be covered separately,

namely compartment syndrome, open fractures,

dislocations, So essentially, these will be in the emergencies.

All right, this will be in the emergencies lecture,

and then Dr. Haydell is going to cover this topic of musculoskeletal infection in a separate lecture as well.

So, well first, this is kind of going to be our outline for this first section of this.

Very basic anatomy and terminology.

We'll go through mechanisms in a little bit of detail,

and evaluation, and then some basic management and treatment.

We'll probably get into that in the next video.

So basic anatomy and terminology.

And this is perhaps going back to gross anatomy and some definitions,

perhaps covered in the radiology session of this block.

but let's just get through some basic definitions to reinforce this.

So understand proximal and distal with regard to the anatomy,

proximal being closer to the center of the body and distal the opposite.

With regard to bone, we're gonna talk a lot about cancellous versus cortical bone.

We'll get into that in the next few slides.

Should understand the diaphysis is the shaft of the bone and it has a medullary canal.

The metaphysis is sort of the trabecular end here.

And then you have the epiphysis with distal and proximal ends of the bone,

which are the articulating or articular portions of the bone.

Here it's gonna be your knee joint and up here is gonna be your hip joint in this femur.

So a few notes about bone structure

so there's essentially the easiest way to break it down it's cortical bone

and cancelus bone

so cortical bone is your compact bone it represents 80% of

the skeleton by by weight it has a very high compressive bending

and rotational strength with a relatively slow turnover of bone

so for instance

if you have a fracture of the cortical bone takes a little bit longer relative to cancelus bone

so cancelus bone is your so-called spongy bone by weight it's 20% of the skeleton it's less dense

and strong and is a high turnover rates

when you have a fracture through cancelus bone it it typically can heal much faster.

And here you can kind of see,

here's an example of a tibia in this image here.

And they're trying to show you a cross section here at the metaphyseal level where you have this

cancellous bone with a somewhat thin cortex and then a periosteum which is sort of the outer layer

of the bone which has blood supply and aids in healing

and also in young children can be very thick and protects the bone mechanically to some degree.

Inside the bone you have the bone marrow.

So you can see the cortical bone,

the end osteal surface, and then the bone marrow.

Here you can see an example of the periosteum being a tissue layer literally being kind of opened up and peeled away,

which potentially can be done surgically if needed.

Okay, and here you see some of those just basic descriptions,

epiphysis, metaphyysis, diaphysis, the medullary canal,

and then the opposite at the other end.

So if you were to look under a microscope,

and of course with some color aids here,

you can see that cortical bone is very dense,

tightly packed osteons, whereas Kensellis bone is a more loose meshwork of trabecula. So some other definitions.

This is something you'll hear a lot of patients ask.

Well, is it fractured or is it broken?

And the fact is, at least as far as medical terminology goes,

it's the same thing.

So we use the terms interchangeably.

Fracture is the same as being broken.

It's defined by a disruption of that bone cortex,

and it can occur in any type of bone or any part of the bone.

And essentially it results in pain, loss of related function.

So of course that makes it difficult to move, needless to say.

And it cannot provide its structural support for the body to stand,

up or to weight bear,

load, use the limb, fight against gravity,

etc. That's why the bone is there.

It's an insertion point for the muscles,

for instance, and that's mechanically unstable when you're fractured.

So by mechanism, fractures occur due to a mechanical failure of bone under stress.

All right, now this can occur or sort of biomechanically by multiple mechanisms.

It could be axial loading.

Bone tends to be fairly strong under compression,

but with enough compression you can get a fracture.

Rotation and torsion, bending, and when you have a bending you potentially have,

so for instance here, you may have bending where the bone is perhaps,

let's just say, hit from here,

there's sort of a bending this way and this way.

So the fracture first occurs here under a tension or bending,

100

and then with compression on the opposite side,

101

then failure occurs out this way.

102

Okay?

103

You can also have a missile injury,

104

and this could be from a gunshot,

105

most typically, or some other high-energy missile penetrating trauma.

106

So here's an image from the textbook, again showing the mechanism.

107

So very simple again, showing a femur.

108

So if this femur were to be loaded,

109

let's say, so if you had this person fall from a height,

110

land on their feet, their feet

111

and the force is directed this way there's going to

112

potentially be this tension occurring on this lateral cortex right and then you're going to get this compression on the

113

medial cortex here and then that's going to lead just like I try to draw in the last image

114

to a failure of the bone right here under tension, failure under tension.

115

And in this case, the compressive forces are not enough to cause any additional fracture like you saw

116

that in that other image,

117

that fracture line's coming out this way.

118

Here you just have a complete fracture line that comes across as a transverse fracture of the femur.

119

so some other terms to keep in mind regarding fracture displacement

120

the fracture can be non-displaced in

121

which basically what a patient may call a hairline fracture they could be displaced

122

which just basically means the fractures are no longer in their

123

usual alignment can be angulated as shown here there's also a term called bayonet

124

meant to sort of invoke the image of a bayonet on a rifle,

125

for instance, in which you have sort of the two fragments overriding each other with slight shortening,

126

or you can have distraction.

127

Distraction essentially means there's a large gap because of either the pawns being pulled apart or perhaps with bone loss,

128

you may use the same terminology.

129

But then essentially when there's a large gap,

130

that can be called distracted.

131

So this is a little bit of a busy slide,

132

but you'll want to take a look at this.

133

You may want to pause the video and sort of make sure you understand this.

134

You'll be hearing these terms in this lecture

135

and possibly in the next several lectures as some of the lecturers may bring up a case with a fracture

136

and use some terminology.

137

So, I've already used this already.

138

So transverse fracture means that the fracture is perpendicular to the shaft of the bone,

139

comes transversely across.

140

Comminuted basically means that there's multiple fragments.

141

Oblique means that there's an angulated fracture line in an oblique fashion.

142

And I'm going to go in a little bit of a different order here.

143

A spiral fracture is really when you have a...

144

it's kind of like oblique,

145

except it tends to spiral around a little bit more,

146

typically from a rotational injury.

147

And then a segmental fracture,

148

shown here, is a fracture where you have essentially a segment,

149

or there's two fracture lines with a floating fragment in the middle.

150

So that's a prototypical segmental fracture there.

151

Now, intra-articular fracture is shown here Intraarticular fracture essentially means that the fracture goes into the joint.

152

So in this case, this is an intraarticular fracture of the medial femoral condyle going into the knee joint.

153

So now I'm going to actually drop down here.

154

We'll talk about impaction.

155

So impaction fracture essentially, this is a term used to describe fractures typically that occur in the metaphyseal region

156

where the bone is, again,

157

a little bit more spongy or the epiphyseal region,

158

and the fracture kind of collapses under,

159

it sort of collapses or shortens and impacts into itself,

160

similar to a compression fracture,

161

except the term compression fracture is used almost exclusively in spinal vertebrae,

162

vertebral bodies as a essentially type of impaction.

163

A depressed fracture or fracture depression is a term used specifically for articular fragments.

164

So up here you saw an intra-articular fracture that really was just a clean fracture line coming down,

165

you could say, whereas here,

166

and the image is small,

167

So you may have to stop,

168

pause, zoom, whatever, to get a better look.

169

But you can see in the tibia,

170

medially, the proximal tibia, there's a depression.

171

Perhaps you could say it's like an impaction,

172

but when it involves the articular surface,

173

and there's this, you know,

174

kind of like step-off, we call that a depression.

175

All right?

176

Then you can have a stress fracture.

177

So stress fracture essentially is a phenomenon that occurs when you either have normal bone that's been overloaded and stressed,

178

or you have abnormal bone that fails because it's weak, essentially.

179

You can have a stress fracture with no trauma.

180

And, you know, this is sort of a very similar phenomenon here.

181

A pathologic fracture, and we'll talk about this in one of the other videos,

182

is a fracture through bone weakened by tumor okay

183

and then here's our uh our two pediatric fracture types you can have a buckle fracture

184

and we'll get into this in the pediatric portion of the lecture or a green stick fracture which is

185

sort of similar but you actually have a tension failure on one side

186

and the other side just does not snap so to speak all right

187

so i'm going to pause there and end this video

188

and we'll pick up with the rest of the lecture in the next video.

189

Thanks.

TRENDING

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법

쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.

☕ 커피 한 잔 사주기

ShadowingEnglish는 여러분의 지원 덕분에 100% 무료로 운영됩니다. 서버 및 AI 유지 비용이 많이 듭니다. 여러분의 커피 한 잔이 큰 힘이 됩니다! ��

PayPal로 기부하기

ShadowingEnglish.com – 영어 쉐도잉 연습

쉐도잉(Shadowing)으로 원어민처럼 영어를 말하세요. YouTube 영상을 한 문장씩 듣고 따라 말하며, 진짜 발음과 유창성을 키우세요. IELTS 학습자들이 선택한 방법.

쉐도잉 연습: General principles of ortho trauma for PA students 1 - basics - YouTube로 영어 말하기 배우기

인기 동영상

이 비디오로 말하기 연습을 해야 하는 이유는?

맥락 속의 문법 및 표현

일반적인 발음 함정

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법

쉐도잉 연습: General principles of ortho trauma for PA students 1 - basics - YouTube로 영어 말하기 배우기

앱 다운로드

이 비디오로 말하기 연습을 해야 하는 이유는?

맥락 속의 문법 및 표현

일반적인 발음 함정

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법