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Hello, everyone. I hope you're all doing well. My name is Rosita and I am the chairperson at accept, welcome to the fourth week of our teaching series. The second session specifically, uh this week, we are focusing on lower limb trauma and orthopedics and we're very happy to have all of you here with us. Uh Today I am joined by Zach who will guide you through the clinical conditions of the lower limb. So that's gonna be a great continuation to our session from yesterday. Uh Just to introduce Zach, he is 1/4 year medical student from the University of Manchester. Uh to make the session as engaging as possible. We will be releasing posts throughout these are completely anonymous. So uh be sure to answer these questions and um make sure to participate actively. If you have any questions during the session, please put them in the chart and we will address them at the end of the session. Uh We'll also share a feedback form at the end. If you complete this, you will receive a certificate of attendance and exclusive discount codes to teach me surgery as well as possible. The MRC the session is being recorded, the recording and the slides will be shared on a metal page as well as our website a couple of hours after the session. So be sure to keep an eye out for that. As you may know, we have launched a very unloading portal which is hosted on our website through this portal. You'll get access to practice questions, session, recordings and revision material. As a bonus, all members will get a discount code to 10% off the GKI Metics, anatomy flash cards, surgical flash cards, and also the knowledge bundle membership is completely free. So be sure to head on to our website after the session to explore this. We also have an exciting opportunity for two of our attendees. Um Two lucky people will win free access to the Kikis surgical flashcards and the kikis of these stations to enter, simply complete the Google form at the end of the session and enter the unique code that we will provide. The more sessions you attend live, the higher your chances of winning. So be sure to stay until the end of today's session and also attend as many of our other sessions, you know, going forward. Finally before we begin, we'd like to thank our partners, the Royal College of Surgeons England, GKI Medics, the MDU M Skin, deep Metal teaching surgery and past the MRC S. Now without further ado I will now have to do to back to take you all through the clinical conditions of below event. Ok. Hi, everyone. My name's Zack. I'm 1/4 year medical student as it was mentioned. And yeah, thank you for coming and thank you to s and their sponsors for having me. So, as it was said, today, we're gonna cover the lower limb. Um, I heard you had your anatomy. So hopefully a lot of this will be relevant to some stuff you've been and again, medical student. So the long list of titles and doctorates aren't quite there yet, but I'm sure there will be one day. So, what is orthopedic surgery? Well, originally, orthopedic derived and hence its name from straightening Children, congenital issues. And it wasn't actually until the 18 nineties when it actually expanded to what we know it as the bone breaking and sticking back together specialty, we know it to be today. Now, obviously, there's some interest in Ortho from quite a lot of you otherwise you wouldn't be here. And I just wanted to share a bit about why I'm interested in Ortho and what I think draws people to it, it's a really, really varied specialty with covering lots of different parts of the body. And it's one of those ones where if you're not quite sure what, which area of the body you want to specialize in, it's very diverse and you can cover things from such as trauma to more elective lists where you know what you're doing, you know, case lists bit by bit. So whether you're into fast paced or slower paced, it's, it's got a lot in it. Now, we need to address the elephant in the room and that elephant being the Ortho, bro stereotype. So if you do enjoy building furniture, using hammers, you bench two plates or more, you hate EC GS, then it might be the, it might be the specialty for you. But let me just say that is not the be all and end all. I hear a lot of people get a bit put off by this and it's absolutely not the case. Not everyone is, you know, jacked up bodybuilder. And if you do have any interest in or I really urge you to go get in contact with your local theaters and go try it out. A lot of people actually get in there. They aren't the stereotype and they just love it. So don't let that stop you. Obviously, I'm a bit biased, but I think it's the coolest surgery ever. So today's topics we're gonna cover quite a wide array of things. I'm not gonna go through the entire list because you've got it there. But essentially I'm gonna take you from classifying fractures to management plans and choosing grafts for an ACL tear. Um Don't worry if you're not used to any of this. I appreciate. Not all of you have had your orthopedic teaching, but we'll go through the basics and we'll, we'll learn some things, the classifying fractures, these are some of the basic ways to do. So there's only a few things that I really want you to take away from this and that is generally the shape of the fracture. So, and whether it's fragmented or not. So in this case, you can see the bottom left here, uh you've got a transverse fracture and that literally means transverse across it and you've got an oblique, there's a few sub characteristics of that. So it could be a spiral. Um But for now just I want you to focus on the shape there. You also have closed and open. Uh an important aspect to remember open is it can't properly be diagnosed until you actually clinically see it. But there's a few telltale signs, for example, on an X ray, there'll be air present in it. Another thing to keep in mind is comminuted. This is a really useful description and it's really useful to pass on to your seniors because it, it will tell you how complicated it is if there's bone retrieval that's necessary within the surgeon within the surgery. Uh A couple of questions though, what's the difference between a fracture and a break? Um There is none. They're both interchangeable terms. Who's the coolest guy in the hospital? The ultrasound guy and quite on point, who's the coolest guy when he's not around the hip replacement guy? I tell a lot of bad jokes and I have a lot of bad, er, a lot of memes in here. So how to diagnose orthos, not exempt from the traditional pattern. You're gonna take a history, a brief one, but you're gonna take a history from the patient. You're gonna perform an examination, you're gonna do some imaging and you're gonna do some investigations following that. Generally speaking, it's the examination and imaging that are your best friends from what I've observed in my placements with that in mind. Though, you need to understand the mechanisms of the human body. You need to understand what muscles and what ligaments move things and how they normally move without doing that. You've got no chance of seeing what's actually wrong. Now, it's one of those things that it sounds basic in, in concept, but it's not, you know, 206 bones in the human body, 600 muscles, 900 ligaments and about 4000 tendons is a lot to remember. Obviously, not all at once, but understanding that mechanism is very, very important and I put some stuff such as trauma and instant swelling here. What I mean by that is there's patterns that you'll get to understand. For example, in a knee injury, instant swelling is indicative of one thing. Whereas gradual swelling is indicative of another thing. In for example, in this case, an ACL tear versus a meniscal tear. So we're gonna run some poll questions if that's ok. Er, if we could get that first question ready. Um We're gonna go for the first question, which is what imaging method is this? I'll give you a, a moment to put that down. So 100% of the people have said x-ray don't even need to explain anything brilliant guy. So, yep, you got an X ray, you'll 100% become familiar with that replacements. Um The translucency of the bones is one thing and the lack of soft tissue detail is another explanation there. But honestly, today, you need to go through that on the next question. Then what type of imaging is this one? OK. So we have a bit of a split here. We have 45 people telling us CT S and 27 people with MRI S. OK. So the answer is, in fact, a CT well done to those who didn't and for those with are quiring MRI. Um We'll come through that, but you can sort of see from the level of soft tissue detail. I think the best way to do that is to compare a picture with an MRI. Uh And I'll guide you some resources through that also. Um Yeah, the, the general appearance of the soft tissue will be a lot more defined in an MRI then, so we'll move on to the next question if that's OK. Uh Hope that clarifies and if it doesn't, I promise you, you will get it clarified by the end of the session. Uh How about this one 80% have gone with MRI. Ok. So yeah, it's absolutely an MRI. Now we were querying what CT was like, didn't want to give too much away. It's not that deep, but um I'm gonna go back a little bit. You can see here the difference across the soft tissue detail that for example, you can see the tendon here connecting at the calcaneus. Um But yeah, honestly, imaging methods, it takes a long time to get used to as long as you recognize in an X ray. I'm very happy. Um I think that's adequate, but you will just come to be able to tell based on the imaging aspect and what is detailed in it. Um And final question is what imaging method is this one? Um And there's a bit of a clue if you're familiar with achilles tendons and their treatment.