PROFESSOR
Fishchenko Vladimir
Alexandrovich

BASHINSKIY GENNADIY
PETROVICH

Traumatology:
•acute injuries,
•polytrauma.
Orthopedics :
•post-traumatic conditions,
•axial deformities,
•congenital and inherited systemic
bone diseases,
•limb developmental defciencies,
•infammatory diseases of bones and
joints,
•musculoskeletal tumors.

QUESTIONING
GENERAL APPEARANCE
LOCAL EXAMINATION
OF THE AFFECTED
AREA

Patient’s complaints (pain,
limitation of function, deformity)
History (type of injury, cause,
time, first aid)
Life history (occupation, habits,
family history, social history,
genetic history, previous injury

Weight
Constitution
Position
Body build
Posture (attitude)
Gait

For the degree of
abnormality aсessment,
simultaneous examination
of the opposite limb
required

 Skin state (ecchymosis, inflamation signs,
tumors bruising, swelling, hematoma,
lacerations, or puncture wounds. Note scars
that indicate previous trauma or surgeries to
the limb)
 Deformities (valgus, varus, antecurvation,
recurvation)
 Extremity length
 Limb circumference measurement
 Muscle strength measurement

Axis of extremity
Axis of upper extremity –
conditionally passes through
the middle of shoulder, radial
and ulnar heads.

Axis of lower
extremity
Axis of lower extremity –
from the front upper iliac
horn through the middle of
patella to the gap between
1st and 2nd fingers on feet.

DEFORMATION OF
EXTREMITY
–Impairments of the axis are:
outside – valgus

–Impairments of the
axis are: inside – varus

Impairments of the axis are:
when the angle is open
forward – recurvatum

Impairments of the axis
are: when the angle is
open backwards –
antecurvatum.

Measuring of length of
limbs
 Common lent of upper extremity
measure from akromial process
of scapula to styloid process of
ulna

The common length of lower
extremity is measured from
the front upper iliac horn to
the top of the inner ankle

The shoulder length is
measured from the
akromion to olecranon;

The length of forearm is
measured from olecranon to
styloid process of ulna

The length of the hip is
measured from greater
trohanter to the head of
fibula

 the length of the crus is
measured from the head of
fibula to the top of the lateral
ankle

There are following types of
shortening
 1) Anatomic shortening.
 2) Relative shortening
 3)projecting shortening
 4) Functional shortening

 The patient or limb position (attitude) –
active, passive, involuntary (forced).
 - Active position indicates on absence of
severe functional disorders in case of
trauma, compensatory adjustments
(adaptation) in orthopedic patients.
 - Passive position indicates on the severity
of trauma, shock. It may be caused by
fractured bones or paralysis.
 - Forced extremity or trunk attitude may be
result of dislocation, inflammation, etc. After
reposition of dislocation, reduction of the

 Contracture is a restriction of passive
movements in the joint.
 1. Antalgic (фprotective, analgetic)
 2. Miogenic (due to one or group of muscles
shortening)
 3. Arthrogenic (due to posttraumatic,
inflammatory or degenerative-dystrophic
changes in the joints).
 4. Desmogenic (scarring of fasciae, ligaments
after trauma and operations)
 5. Dermatogenic (after extensive burns)
 6. Neurogenic (in cases of flaccid, spastic
paralyses)
 7. Tenogenic (reducing of a tendon or its

 Joint stiffness is a state insignificant
(that does not exceed 3-5°) oscillatory
motions are saved in a joint.
 Ankylosis is a complete absence of
movements. Ankyloses may be fibrous
and bony (true), intra-articular and
extra-articular, concordant (in
functionally advantageous position) and
and discordant (in functionally

 Absolute signs of fracture:
 - Visible deformation (axis
violation)
 - Crepitation
 - Pathological mobility
 - True shortening
 - Pain during axis loading

 Absolute signs of dislocation (luxatio):
 - Forced limb position
 - Violation of the joint lines
 - Palpation of the head outside the joint
cavity
 - Relative (dislocational) shortening or
lengthening
 - Active movement is impossible, but
passive - elastic

Rozer-Nelaton’s
Rozer-Nelaton’s line
connects tuber of iscium and
the front upper iliac horn. It is
used to determine
pathological states in the hip
joint. Normally, hip is bent at
an angle of 130°, the greater
trochanter is palpated on this

Shemaker’s line
Shemaker’s line connects
the tip of the greater
trochanter and the front
upper iliac horn. Conditional
continue of the line usually
passes above the navel.

Brian’s triangle
Brian’s triangle is formed by
a line drawn along the axis of
the aligned hip up to the
crossing with the
perpendicular, which starts
from the front upper iliac
horn. It connects it with a

Marx’s line
Marx’s line connects both
epicondyles of the shoulder
bone and normally is
perpendicular to the
longitudinal axis of the bone.

Huter’s triangle
Huter’s triangle is formed
during forearm flexion at 90°
by three bone shelves: both
of epicondyles and the tip of
olecranon.

Huter’s line
Huter’s line in the unbent
position connects two
epicondyles and the tip of
olecranon.

Look
 Swelling
 Bruising
 Deformity
 Overlying skin
 Adjacent joint
 Limb shortening
Local examination

Feel
 Temperature
 Tenderness
 Swelling
 Peripheral sensation
 Peripheral pulses
Local examination

Move
No attempt should be made
to elicit abnormal mobility or
crepitus in a fractured bone.
Joint movements should only
be tested if patients can
perform them actively without
Local examination

POSTURE

Pt’s neck appears short and broad. Pt’s hairline is low and an associated
Sprengel deformity is present, the left scapula being hypoplastic and high
riding. As a result, the patient is unable to fully raise his left arm.

CT

Stages of fracture healing
(Frost 1989)
1. Stage of haematoma
Approximate time: Less than 7 days
Essential features: Fracture- end necrosis
occurs. Sensitisation of precursor cells.
2. Stage of granulation tissue
Approximate time: Up to 2 – 3 weeks;
Essential features: Prolifiration and
differentiation of daughter cells into

3. Stage of callus
Approximate time: 4 – 12 weeks;
Essential festures: Mineralisation of
granulation tissue. Callus radiologically
visible. Fracture clinically united, no
more mobile.
4. Stage of remodelling
Approximate time: 1 – 2 years;
Essential features: Lamellar
boneformation by multicellular unit
based remodelling of callus. Outline of

5. Stage of modelling
Approximate time: Many years;
Essential features: Modelling of endosteal
and periosteal surface so that the
fracture-site becomes indistinguishable
from the parent bone.

Consilidation of bone tissue may
be due to next bone callus:
 Endosteal
 Periosteal
 Paraosseous
 Intermediary

Consolidation of bone tissue devides to
primary consolidation and secondary
consolidation
 Primary consolidation as rool due to
intermedial callus. It’s much more
complete;
 And secondary as rool due to periostal
callus.