Primary Surgery Vol.2 – Trauma

Last update/addition: 02. May 2008

This is a clone of the original printed edition.

50 Introduction
- 50.1 A system of traumatology
- 50.2 Preventing trauma
- 50.3 At the scene of the accident
  - THE MINIMUM REQUIREMENTS FOR AN AMBULANCE
51 The severely injured patient
- 51.1 Caring for a severely injured patient
  - THE CARE OF A SEVERELY INJURED PATIENT
- 51.2 Monitoring an injured patient
- 51.3 Some particularly difficult combined injuries
- 51.4 Mass casualties
  - MASS CASUALTIES
52 The airway
- 52.1 The general method for airway obstruction
  - THE GENERAL METHOD FOR AIRWAY OBSTRUCTION
- 52.2 Laryngotomy and tracheostomy
  - LARYNGOTOMY AND TRACHEOSTOMY
- 52.3 Injuries of the larynx and trachea
53 Shock
- 53.1 Four kinds of shock
- 53.2 Hypovolaemic shock after an injury
- 53.3 Renal failure after an injury
  - POST TRAUMATIC RENAL FAILURE
- 53.4 Septic shock
54 Wounds
- 54.1 Preventing infection—the wound toilet
  - THE IMMEDIATE WOUND TOILET
- 54.2 Immediate primary suture
  - IMMEDIATE PRIMARY SUTURE
- 54.3 Some bitter lessons from early suture
- 54.4 Delayed primary suture (dps)
  - DELAYED PRIMARY SUTURE
- 54.5 Delayed wound toilet
  - SECONDARY WOUND TOILET
- 54.6 Secondary suture
- 54.7 Chronically infected wounds
- 54.8 Wounds which leave flaps
- 54.9 Degloving or avulsion injuries
- 54.10 Missile wounds
- 54.11 Preventing surgical tetanus
  - PREVENTING SURGICAL TETANUS
- 54.12 Treating tetanus
  - TREATING TETANUS
- 54.13 Gas gangrene
  - GAS GANGRENE
55 Injuries to vessels, nerves and tendons
- 55.1 Immediate treatment for a severely bleeding wound
  - IMMEDIATE TREATMENT FOR A BLEEDING WOUND
- 55.2 Definitive treatment for severe arterial bleeding
- 55.3 The cold blue injured limb
- 55.4 A stab wound close to a major artery
- 55.5 A pulsating (arterial) haematoma
- 55.6 Repairing blood vessels
  - REPAIRING BLOOD VESSELS
- 55.7 Saphenous vein grafts
- 55.8 Examining the peripheral nerves
- 55.9 Primary nerve repair
  - PRIMARY NERVE REPAIR
- 55.10 Secondary nerve repair by trial section
  - TRIAL SECTION AND RESUTURE
- 55.11 Tendon injuries
56 Amputations
- 56.1 The general method for amputations
  - GENERAL METHOD FOR AMPUTATIONS
- 56.2 Guillotine amputations
- 56.3 Amputating for ischaemic gangrene
- 56.4 Amputating through the upper arm and elbow
  - AMPUTATING THROUGH THE UPPER ARM
- 56.5 Amputating through the lower arm and wrist
  - AMPUTATING THROUGH THE FOREARM
- 56.6 Amputation above the knee
  - AMPUTATING ABOVE THE KNEE
- 56.7 Disarticulating the knee
  - DISARTICULATING THE KNEE
- 56.8 Amputating below the knee
  - AMPUTATING BELOW THE KNEE
- 56.9 Syme’s amputation
  - SYME’S AMPUTATION
- 56.10 Amputating through the foot and toes
  - AMPUTATING THROUGH THE FOOT AND TOES
57 Skin grafts and flaps
- 57.1 Different kinds of graft
- 57.2 Split skin grafting
- 57.3 Preparing granulation tissue for grafting
  - PREPARING GRANULATION TISSUE
- 57.4 Why grafts don’t take—infection, bleeding, anaemia, and movement
- 57.5 The general method for split skin grafting
  - GENERAL METHOD FOR SPLIT SKIN GRAFTING
- 57.6 The exposure method for dressing a graft
- 57.7 Grafting with open knife or a razor
- 57.8 Storing grafts
- 57.9 Pinch grafts
  - 57.9.1 PINCH GRAFTING
- 57.10 Full thickness skin grafts
  - FULL THICKNESS GRAFTS
- 57.11 Some of the simpler flaps
  - SKIN FLAPS
  - PARTICULAR FLAPS
- 57.12 W–plasties
58 Burns
- 58.1 Caring for a severe burn
  - THE GENERAL METHOD FOR BURNS
- 58.2 Prevention and physiology
- 58.3 What percentage of a patient’s body surface has been burnt?
- 58.4 How much fluid does a shocked patient need?
  - IMMEDIATE FLUID REPLACEMENT IN BURNS
- 58.5 What kinds of fluid does a severely burnt patient need?
- 58.6 Should you let a burns patient drink?
- 58.7 Does a burns patient need blood?
- 58.8 If resuscitation starts late
- 58.9 How much fluid does a burns patient need when shock is over?
- 58.10 Difficulties with fluid and blood replacement
  - DIFFICULTIES WITH FLUID IN A SEVERELY BURNT PATIENT
- 58.11 Feeding a burn patient (or any severely injured patient who can eat
  - FEEDING
- 58.12 How deep are the patient’s burns?
  - HOW DEEP ARE A PATIENT’S BURNS?
- 58.13 How should the burn itself be treated?
  - HOW SHOULD A BURN BE TREATED?
- 58.14 The exposure method
  - THE EXPOSURE METHOD FOR BURNS
- 58.15 The closed (occlusive dressing) method
  - THE CLOSED (OCCLUSIVE) METHOD FOR BURNS
- 58.16 The saline method for burns
- 58.17 Early excision and grafting for a full thickness burn
- 58.18 Sloughs and eschars
  - ’SLOUGHECTOMY’ AND ESCHAROTOMY FOR A DEEP BURN
- 58.19 Grafting burns
- 58.20 Preventing infection in burns
- 58.21 Systemic antibiotics for burns
- 58.22 Local (topical) antibacterial agents
  - MAKING DRESSINGS FOR BURNS
- 58.23 Difficulties with infected burns
- 58.24 Preventing contractures
  - PREVENTING CONTRACTURES
- 58.25 Treating broad burns contractures
  - THE GENERAL METHOD FOR A BROAD CONTRACTURE
- 58.26 Z–plasties for narrow contractures
  - Z–PLASTIES
- 58.27 Burnt respiratory tract
  - RESPIRATORY BURNS
- 58.28 Burnt eyes
  - BURNT EYES
- 58.29 Burnt hands and feet
  - BURNT HANDS
- 58.30 Burnt face and ears
- 58.31 Burns of the trunk
- 58.32 Burnt bones and joints
59 Atomic trauma
- 59.1 The final challenge to preventive surgery
- 59.2 Trauma from heat, blast and radiation
- 59.3 Radiation injury
  - ’RADIATION SICKNESS’
  - SOME POSSIBLE MEASURES
- 59.4 A nuclear Hippocratic oath
60 Eye injuries
- 60.1 The general method for eye injuries
  - GENERAL METHOD FOR AN INJURED EYE
- 60.2 Haematoma of the eyelid (’black eye’)
- 60.3 Injuries of the eyelids, canaliculi, and conjunctiva
  - INJURIES OF THE EYELIDS
- 60.4 Injuries of the cornea and sclera
  - INJURIES OF THE CORNEA AND SCLERA
- 60.5 Injuries of the iris
- 60.6 Penetrating injuries of the globe
- 60.7 Blunt injuries of the globe
- 60.8 Bleeding into an injured eye
- 60.9 Foreign bodies in the eye
  - FOREIGN BODIES IN THE EYE
- 60.10 Endophthalmitis after an injury
61 Lesser face injuries
- 61.1 The general method for lesser face injuries
  - GENERAL METHOD FOR LESSER FACE WOUNDS
- 61.2 Injuries of the lips, the gums, and the tongue
  - INJURIES OF THE LIPS, THE GUMS, AND THE TONGUE
- 61.3 Injuries of the cheek, the facial nerve, and the parotid gland
  - STRUCTURES IN THE CHEEK
- 61.4 Injuries of the ear and the nose
  - EAR AND NOSE INJURIES
62 Maxillofacial injuries
- 62.1 The general method for maxillofacial injuries
  - THE GENERAL METHOD FOR A MAXILLOFACIAL INJURY
- 62.2 Injuries to the teeth an alveolus
  - INJURIES TO THE TEETH AND ALVEOLUS
- 62.3 Simpler methods for maxillary fractures
- 62.4 Fractures of the nose
  - TREATING A BROKEN NOSE
- 62.5 Fractures of the zygomatic complex
  - ELEVATING A FRACTURED ZYGOMA
- 62.6 Dislocation of the jaw
  - REPLACING A DISLOCATED JAW
- 62.7 The general method for an injured lower jaw
  - THE GENERAL METHOD FOR AN INJURED LOWER JAW
- 62.8 Fractured mandibular condyles
  - FRACTURES OF THE MANDIBULAR CONDYLES
- 62.9 Fractures of the ascending ramus of the mandible
- 62.10 Fractures of the angle or body of the mandible
  - FRACTURES OF THE BODY OF THE MANDIBLE
- 62.11 Fixing mandibular fractures with resins
  - FIXING THE MANDIBLE IN OTHER WAYS
63 Head injuries
- 63.1 The general method for head injuries
  - THE GENERAL METHOD FOR AN UNCONSCIOUS PATIENT WITH A HEAD INJURY
- 63.2 Monitoring a patient with a head injury
- 63.3 Patterns of head injury
- 63.4 The prognosis in head injuries
- 63.5 Should you make burr holes, and if so where?
- 63.6 Making burr holes
  - SUBDURAL AND EXTRADURAL BLEEDING
- 63.7 Open head wounds
  - OPEN HEAD WOUNDS
- 63.8 Fractures of the vault of the skull
  - FRACTURES OF THE VAULT
- 63.9 Ping–pong ball skull fractures in children
- 63.10 63.9 Controlling bleeding in head injuries
  - CONTROLLING BLEEDING IN HEAD INJURIES
- 63.11 Hyperthermia after a head injury
- 63.12 Convulsions after a head injury
- 63.13 When CSF leaks from the patient’s nose or ears
- 63.14 Meningitis follows a head injury
- 63.15 More difficulties with a head injury
64 The spine
- 64.1 Introduction
- 64.2 Syndromes of spinal injury
- 64.3 Caring for a spinal injury
  - THE GENERAL METHOD FOR A SPINAL INJURY
- 64.4 Interpreting the X–rays
  - IS A SPINAL INJURY UNSTABLE?
- 64.5 Managing injuries of the cervical spine
- 64.6 Collars and traction tongs
  - APPLIANCES FOR NECK INJURIES
- 64.7 Skeletal traction
- 64.8 Fractures of the atlas and axis
- 64.9 Cervical hyperextension injury (’porter’s neck’)
- 64.10 Torticollis at birth
- 64.11 Torticollis in older children
- 64.12 Fractures of the thoracic and lumbar spine
- 64.13 Paraplegia
- 64.14 A paraplegic’s morale
- 64.15 A paraplegic’s skin
- 64.16 Paraplegic’s bladder
- 64.17 A paraplegic’s bowels
- 64.18 The muscles and joints in paraplegia
- 64.19 Mobilizing and rehabilitating the paraplegic
65 Thoracic injuries
- 65.1 The general method for a thoracic injury
  - THE GENERAL METHOD FOR A CHEST INJURY
- 65.2 Draining the pleural cavity
  - DRAINING BLOOD OR AIR FROM THE CHEST
- 65.3 Uncomplicated fractures of the ribs and sternum
- 65.4 Haemothorax and haemopneumothorax
  - HAEMOTHORAX AND HAEMOPNEUMOTHORAX
- 65.5 Pneumothorax
  - PNEUMOTHORAX
- 65.6 Flail chest
  - FLAIL CHEST
- 65.7 Open chest wounds
- 65.8 Stab wounds of the chest
- 65.9 Cardiac tamponade
- 65.10 Other difficulties with a chest injury
66 The abdomen
- 66.1 The general method for an abdominal injury
  - GENERAL METHOD FOR ABDOMINAL INJURIES
- 66.2 Penetrating abdominal injuries
  - PENETRATING ABDOMINAL INJURIES
- 66.3 Laparotomy for abdominal injuries
- 66.4 Rupture of the abdominal wall (evisceration of the gut)
- 66.5 Rupture of the diaphragm
- 66.6 Injuries of the spleen
  - RUPTURED SPLEEN
- 66.7 Liver injuries
  - RUPTURED LIVER
- 66.8 Stomach injuries
- 66.9 Small gut injuries
  - SMALL GUT INJURIES
- 66.10 Injuries to the mesentery
  - TEARS AND HAEMATOMAS OF THE MESENTERY
- 66.11 Large gut injuries
- 66.12 Injuries of the caecum
  - CAECOSTOMY
- 66.13 Injuries of the right colon from the caecum to the hepatic flexure
  - INJURIES OF THE RIGHT COLON BEYOND THE CAECUM
- 66.14 Injuries from the hepatic flexure to the rectum
  - INJURIES OF THE TRANSVERSE, DESCENDING, AND SIGMOID COLON
- 66.15 Injuries of the rectum
  - INJURIES OF THE RECTUM
- 66.16 Duodenal injuries
  - INJURIES OF THE DUODENUM
- 66.17 Pancreatic injuries
  - THE PANCREAS
- 66.18 Injuries of the gall bladder
- 66.19 Other difficulties with abdominal injuries
  - DIFFICULTIES WITH AN ABDOMINAL INJURY
67 Kidney injuries
- 67.1 The general method
  - THE GENERAL METHOD FOR A KIDNEY INJURY
- 67.2 Operations for kidney injuries
  - OPERATING ON AN INJURED KIDNEY
68 The lower urinary and genital tract
- 68.1 The general method for an injury of the lower urinary tract
  - THE GENERAL METHOD FOR INJURIES OF THE LOWER URINARY TRACT
- 68.2 Rupture of the bladder
  - RUPTURE OF THE BLADDER
- 68.3 Rupture of the posterior urethra (injuries C, and D)
  - POSTERIOR URETHRAL INJURIES
- 68.4 ’Railroading’
  - RAILROADING
- 68.5 Injuries of the penile urethra (injuries E, and F)
- 68.6 Extravasation of urine complicating urethral injuries
- 68.7 Strictures after urethral injuries
- 68.8 Injuries of the penis and scrotum
  - INJURIES OF THE PENIS AND SCROTUM
69 Broken bones
- 69.1 Examining a injured limb
  - THE GENERAL METHOD FOR AN INJURED LIMB
- 69.2 X–rays for bony injuries
- 69.3 Adequate function with minimum risk
- 69.4 For the purposes of closed treatment there are three groups of fractures
- 69.5 Fractures of the shafts of long bones
- 69.6 How should you treat a broken long bone?
- 69.7 Fractures of the ends of long bones
- 69.8 Varieties of bony injury
- 69.9 Fractures in children
- 69.10 Epiphyseal injuries in children
- 69.11 Open fractures
  - OPEN FRACTURES
- 69.12 Open joint wounds
- 69.13 Pathological fractures
- 69.14 Active movements means active movements!
  - SOME EXERCISES
70 Plaster and traction
- 70.1 Plaster, and the equipment for it
- 70.2 Slabs or a circular cast?
- 70.3 Splitting and spreading a cast
- 70.4 Catastrophes with casts
- 70.5 Make your own plaster bandages
- 70.6 Plastercraft
  - BASIC PLASTERCRAFT
- 70.7 Windowing casts and wedging them
- 70.8 Chinese wooden splints
- 70.9 Traction
  - TRACTION METHODS SUMMARIZED
  - EQUIPMENT FOR BONE TRACTION
- 70.10 Skin traction
- 70.11 Skeletal traction
  - STEINMANN’S AND DENHAM’S PINS
- 70.12 Skeletal traction with Kirschner wires
- 70.13 Kirschner wire for bone fixation
71 The shoulder and upper arm
- 71.1 Introduction
  - EXAMINING THE SHOULDER AND UPPER ARM
- 71.2 Casts, slings, and exercises for injuries of the upper limb
- 71.3 Injuries of the brachial plexus
- 71.4 Fractures of the clavicle
- 71.5 Dislocations of the sterno–clavicular joint
- 71.6 Dislocation of the acromio–clavicular joint
- 71.7 Fractures of the scapula
- 71.8 Anterior dislocation of the shoulder
  - ANTERIOR SHOULDER DISLOCATION
- 71.9 Posterior dislocation of the shoulder (rare)
- 71.10 Fracture of the greater tuberosity
- 71.11 Fractures of the neck of the humerus
- 71.12 Fractures of the neck of the humerus in adults
- 71.13 Fractures of the neck of the humerus in children
- 71.14 Dislocation of the shoulder with fracture of the neck of the humerus
- 71.15 Displacement of the upper humeral epiphysis
- 71.16 Fractures of the shaft of the humerus
  - FRACTURES OF THE SHAFT OF THE HUMERUS
- 71.17 Fractures of the humerus, radius, and ulna
72 The elbow
- 72.1 Introduction
  - EXAMINING THE ELBOW
- 72.2 X–rays of the elbow
- 72.3 Elevating and aspirating the elbow
- 72.4 Dislocation of the elbow
  - REDUCING A DISLOCATED ELBOW
- 72.5 Posteriorly displaced supracondylar fractures in children
  - A CHILD’S SUPRACONDYLAR FRACTURE POSTERIORLY DISPLACED
- 72.6 Supracondylar fracture of the humerus in children with anterior displacement of the distal fragment
- 72.7 Ischaemia following a supracondylar fracture
- 72.8 Forearm traction fails to restore the pulse of a child with a supracondylar fracture
- 72.9 Other difficulties with supracondylar fractures in children
- 72.10 Supracondylar fractures of the humerus in adults
  - SUPRACONDYLAR FRACTURES OF THE HUMERUS IN ADULTS
- 72.11 Fracture of the medial epicondyle of the humerus
- 72.12 Fracture of the lateral condyle of the humerus (children)
- 72.13 Fracture of the capitulum (adults)
- 72.14 Fractures of the head of the radius (adults)
  - FRACTURES OF THE HEAD OF THE RADIUS
- 72.15 Pulled elbow (young children)
- 72.16 Fracture of the neck of the radius (children)
- 72.17 Fractures of the olecranon
  - FRACTURES OF THE OLECRANON