Treatment Algorithm

by Stuart Enoch, PhD

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    00:01 What are the affected decision is this? Well, intracapsular or extracapsular, number 1.

    00:07 Number 2, that's your algorithm.

    00:10 So intracapsular.

    00:18 So that is a head.

    00:22 If it is minimally displaced or non-displaced as gardens 1 and 2.

    00:29 One and two you can either treat it conservatively, or use IVUS screws cannulated screws 1 & 2, 3 & 4 are displaced fractures.

    00:40 3 and 4 as you said, if the patient is elderly then you go for hemiarthroplasty.

    00:45 If it is an impatient say 28 year-old, gardens 4, fracture, then you go for a total hip replacement.

    00:54 All this patient's you always have to consider whether it's, any point in treating it consecutively.

    01:10 Okay, displaced.

    01:14 Yeah.

    01:18 Yeah.

    01:34 For the exam it says three and four hemiarthroplasty or hip replacement.

    01:40 No.

    01:41 No, usually from 1 and 2, we are allowed, there are have allowed that it screws.

    01:48 You can, yeah.

    01:50 That's right, yeah.

    01:52 But did you understand what she is trying to get at, it's very important point? In the elder patient, you need to try to preserve the head as much as you can, because you don't want to put hemiarthroplasty, but then the compromises gardens 3, by preserving it will or making it more, is there a risk of avascular necrosis.

    02:15 Yeah, but the exam, 1 and 2 go for screws.

    02:21 Hemiarthroplasty or totally replacement.

    02:23 Okay, so intracapsular fractures, undisplaced 1 and 2, grade 1, grade 2, displaced 3 and 4.

    02:32 Undisplaced intracapsular that is 1 and 2, conservative or cannulated screws? That one.

    02:40 Displaced intracapsular, that is 3 and 4.

    02:43 You can treat it conservatively, the patient is unfit for surgery.

    02:47 Then here this is exactly.

    02:50 You're right.

    02:50 This is exactly what he said whether you need to go for cannulated screws to preserve it.

    02:54 But in the exam, they won't be in that nasty.

    02:59 I haven't seen any question where they given a forty-year-old with...

    03:04 Yeah mobile and fit or unfit one of them, but you know, yeah, yeah.

    03:15 Because this is such a gray area, you really don't have a correct answer for a 34-year-old part grade 2 or 3, what are you going do, it's a very individual clinical decision.

    03:27 But for exam you can go for...

    03:31 okay, so that's a hemiarthroplasty.

    03:38 This is a extracapsular fracture, intertrochanteric fracture.

    03:43 There is no threat to the blood supply.

    03:44 It has got a large surface area for bony union.

    03:49 So, if it is a two-part intertrochanteric fracture, pretty much straightforward, go for a DHS.

    03:57 If it is multi-part, pertrochanteric or subtrochanteric, or even for a femur you go for IM nail.

    04:04 I think that's all.

    04:06 Okay, because similar to the stroma, similar to the hemicolectomy, right hemi, left hemi and the resection, etc.

    04:16 This is something which comes up, you need to know the difference between intracapsular, extracapsular.

    04:21 When do you do, what? Any question on those? Are you absolutely certain about this part? The intracapsular, extracapsular, you are sure? Anyone? No.

    04:35 Okay.

    04:38 So, trauma, head injury, scaphoid, fracture neck of femur and shock.

    04:45 Is there anything you want to ask? I'm sure there are so many things we haven't covered.

    04:49 We just don't have the time to cover.

    04:51 But is there anything you think, "Oh I should have asked this".

    04:56 No.

    04:57 As I said, this is nothing more than file a medical student.

    05:00 It's exactly that level, in this part of the exam, only certain things they go to a slightly higher level.

    05:11 For SPC or normal catheterization.

    05:14 Yeah.

    05:16 Hydrating prostate, blood in the urethral meatus.

    05:20 Yeah.

    05:24 And we need to scan them first, then super your only option.

    05:29 Yeah, four or five of those.

    05:33 It's hydrating prostate, blood in the urethral meatus, scrotal bruising, scrotal or perennial bruising, then what's this one more important we do.

    05:45 They'll come to me, if you're suspecting prindle injury.

    05:49 Yeah.

    05:55 Okay, the other one we need to do is burns.

    06:06 Now, burns, you probably will get about two questions.

    About the Lecture

    The lecture Treatment Algorithm by Stuart Enoch, PhD is from the course Trauma and Post-OP Management.

    Author of lecture Treatment Algorithm

     Stuart Enoch, PhD

    Stuart Enoch, PhD

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