UkuZinziswa koKuqhekezwa kwePelvic, ukuBophelela okuCwangcisiweyo, kunye nokuBopha kwaNgaphakathi¶

I-high-energy ** i-pelvic ring fracture ** yenye yokulimala kakhulu kwiyeza elibuhlungu, elithwele izinga lokufa kwe-15 ukuya kuma-50 ekhulwini xa lihamba kunye nokungazinzi kwe-hemodynamic. Ngokungafani nethambo elide elifana ne-shin okanye i-forearm, i-pelvis yomntu iyindandatho eqinile eyenziwe ngamathambo amabini amakhulu angabonakaliyo (i-hip) ahlangene phambi kwe-** pubic symphysis ** kwaye agxininiswe ngasemva kwi- sacrum ** yi-ligaments eqinile emzimbeni. Xa imoto ehamba ngesantya esiphezulu, ukungqubana kwesithuthuthu (apho i-pelvis ibetha phambili kwi-tank yamafutha), ukubetha kwabahambi ngeenyawo, ukulimala, okanye ukuwa ukusuka kumphakamo kuphula le ntsimbi kwiindawo ezimbini kunye nokukrazula i-ligaments ye-sacroiliac yangasemva, i-pelvis i-hinges ivuleke njengeekhava zencwadi ( "incwadi evulekileyo" i-pelvic fracture * *).

Njengoko indandatho ye-pelvic yamathambo ivuleka, umthamo wayo wangaphakathi we-spherical wanda kakhulu, udala indawo enkulu ye-retroperitoneal vacuum ekwazi ukugwinya ** i-3,000 ukuya kwi-5,000 milliliters (6 ukuya kwi-10 pints) yegazi ** (umthamo wegazi elijikelezayo lonke lomguli) ngaphandle kwethontsi legazi elibonakala ngaphandle kwesikhumba. Okona kubi kakhulu, abahlanguli abaneenjongo ezintle bahlala bebulala amaxhoba okwenzakala kwi-pelvic ngokutyhala okanye ukunyakazisa i-hip crests ukuze "bavavanye ukwaphuka" okanye ngokuqengqeleka isigulana kwicala labo, nto leyo eqhekeza amahlwili egazi e-retroperitoneal. Ukwazi ukuba kutheni ungaze ushukumise i-pelvis , kutheni i-pelvic binder okanye i-bedsheet ephuculweyo kufuneka igxininiswe ngokungqongqo phezu kwe- i-trochanters enkulu yeefemurs ** (kwaye ** ungalokothi ** uphakame phezulu esinqeni okanye i-iliac crests), kunye nendlela yokubopha amadolo kunye namaqatha ekujikelezeni kwangaphakathi ivala i-pelvic ubomi kunye nokugcina ubomi be-pelvic.

Yenza oku ngoku¶

1. Fowunela inombolo yakho kaxakeka ngokukhawuleza kwaye ucele i-Advanced Life Support (ALS) i-paramedics yezothutho ezingxamisekileyo zeNqanaba loku-1 leZiko leTrauma. Dial 911 eUnited States naseKhanada, 112 kulo lonke elase-European Union, 999 e-United Kingdom, 000 e-Australia, okanye khangela incwadi amanani kaxakeka.
2. UNGAZE "intwasahlobo," ingxonde, ityhale, okanye icinezele amathambo enyonga ukujonga ukuba i-pelvis yaphukile na. Ukutyhala phantsi okanye ngaphakathi kwi-pelvis engazinzanga kusila amaqhekeza amathambo abukhali kwi-sacral venous kunye ne-internal iliac arteries, kukhupha amahlwili egazi okuqala abuthathaka agcina umguli ephila. Ukuba indlela yokulimala okanye iimpawu zibonisa ukuphuka kwe-pelvic, ** cinga ukuba i-pelvis iphukile kwaye ibophe **.
3. UNGAZE ugibele ixhoba elirhanelekayo lokwaphuka kwe-pelvic ecaleni lalo ngaphandle kokuba indlela yabo yomoya ivalwe ngumhlanzo okanye igazi. Ukuqengqela umntu owenzakeleyo kwicala le-pelvis eyaphukileyo kutyumza iphiko le-iliac ngaphakathi kwaye kuchebe imithambo ye-retroperitoneal. Gcina isigulane sithe tyaba emqolo (supine) kwaye usebenzise i-multi-rescuer flat flat lift ("ibhulorho yokunyuswa") okanye i-scoop stretcher ukuba intshukumo ayinakuphepheka.
4. **Faka i-Pelvic Binder yorhwebo (i-SAM Pelvic Sling, T-POD, okanye i-Prometheus) okanye i-Bedsheet Binder esongiweyo egxile ngokungqongqo kwi-GRREATER TROCHANTERS (amaqhuma amathambo kumathanga/amathanga aphezulu), AKUKHO phezu kwesinqe okanye i-hip crests ephezulu. inqanaba le-trochanters enkulu kunye ne-pubic symphysis iphakamisa iintloko ze-femur ngaphakathi ukuvala "incwadi evulekileyo" ye-pelvis.
5. Jikela imilenze yomibini ngobulali ngaphakathi ("ihobe-uzwane") kwaye ubophe ibhandeji elinesibhozo okanye ipad-and-strap emadolweni nasemaqatheni. Kuba ibhola yethanga (intloko yefemoral) ihlala ngaphakathi kwisokethi yenyonga (i-acetabulum), ukujikela iinyawo namadolo ngaphakathi kusebenzisa iintsinjana ezisuka kwi-femu kunye nezithinteli eziphuma kwi-femu. ubuye uvulwe.
6. Gcina umguli ngokungqongqo i-NPO (akukho nto ngomlomo) kwaye usonge intloko-to-enzwaneni kwiingubo ezifudumeleyo ukunqanda i-hypothermia kunye ne-coagulopathy. Ukopha kwe-Pelvic ikakhulu kuxinzelelo oluphantsi lwe-venous kunye nokurhoxisa ukopha kwethambo okuxhomekeke kwi-clotting factor yesigulana ukuze tamponade; ukuba isigulana siyagodola kwipavumente, ii-enzyme ezijiyisayo ziyavaleka kwaye ukopha kwangaphakathi akunqandeki.

Umthi wesigqibo esingxamisekileyo ngenxa yokwaphuka komsesane we-pelvic¶

flowchart TD
    Start["High-Energy Blunt Trauma: Motor Vehicle Crash, Motorcycle Impact,<br/>Pedestrian Struck, Fall > 3 m (10 ft), Horse Trampling, or Crush Injury"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Keep patient strictly flat (supine); DO NOT log-roll onto side;<br/>DO NOT push or rock the hips ('No Pelvic Springing')"]
    AssessSigns{"Are Pelvic Fracture Criteria or Visual Signs Present?<br/>- Severe hip, groin, lower back, or sacroiliac pain<br/>- Unexplained tachycardia / shock after blunt trauma<br/>- One or both legs flopped outward (external rotation) or one leg shorter<br/>- Bruising over scrotum/labia, perineum, flanks, or blood at urethra"}
    NoPelvic["NO PELVIC FRACTURE SUSPECTED<br/>Continue standard trauma assessment, spinal precautions,<br/>and shock warming until EMS arrival"]
    PrepBinder["PREPARE FOR CIRCUMFERENTIAL PELVIC STABILIZATION<br/>1. Empty trouser pockets (remove keys, wallet, phone, belt)<br/>2. Select Commercial Pelvic Binder (SAM Sling / T-POD)<br/>   OR fold a strong cotton bedsheet smoothly to 15-20 cm (6-8 in) width"]
    SlideSheet["SLIDE BINDER UNDER PATIENT WITHOUT LIFTING OR LOG-ROLLING<br/>1. Pass binder under the natural hollow beneath the KNEES<br/>2. Use a smooth 'seesaw' sawing motion to slide sheet up beneath lower thighs/buttocks<br/>3. Center strictly over the GREATER TROCHANTERS & PUBIC SYMPHYSIS<br/>   (NOT high up over the iliac crests / waist)"]
    TightenLeg["CLOSE THE PELVIC RING & INTERNAL-ROTATE LEGS<br/>1. Have assistant gently bring legs together and rotate feet INWARD ('pigeon-toed')<br/>2. Pull binder straps/sheet ends firmly across front of greater trochanters<br/>3. Lock commercial buckle OR twist/clamp/tie sheet ends securely in front<br/>4. Pad between knees/ankles and tie figure-of-eight strap around ankles & knees"]
    ShockCare["PREVENT LETHAL TRAUMA TRIAD & MONITOR<br/>1. Wrap patient in warm blankets / thermal foil<br/>2. Keep strictly NPO (nothing by mouth)<br/>3. Do NOT remove or loosen pelvic binder until inside Trauma Resuscitation Bay"]

    Start --> CallEMS
    CallEMS --> AssessSigns
    AssessSigns -->|No| NoPelvic
    AssessSigns -->|Yes: Any Criterion Present| PrepBinder
    PrepBinder --> SlideSheet
    SlideSheet --> TightenLeg
    TightenLeg --> ShockCare

Ukuthelekisa iintlobo ezine ze-Young-Burgess ze-pelvic ring fractures¶

Iingcali ze-Orthopedic trauma surgeons zihlula i-pelvic ring fractures ngesalathiso samandla atyumzayo (**Uluhlu lwe-Young-Burgess **). Ukuqonda indlela i-pelvis ephuka ngayo ichaza ukuba kutheni "incwadi evulekileyo" ibangela ukuba imilenze iphumele ngaphandle kwaye kutheni ukopha kwangaphakathi kuyingozi.

Anatomy and pathophysiology: Why a broken pelvis can bleed out 5 liters of blood internally¶

1. The Geometry of a Sphere: Why opening the pelvis by 5 centimeters creates a giant blood reservoir¶

Inside an intact adult pelvis, the bony ring encloses a compact hemispherical basin of roughly 1.5 liters (3 pints), tightly packed by tough parietal peritoneum and fascia. If a small blood vessel tears inside an intact pelvis, blood quickly fills that small, tight space until the pressure of the trapped blood equals the pressure inside the veins, naturally plugging the leak (self-tamponade).

However, in an open-book (APC) or vertical-shear pelvic fracture, the pubic symphysis rips open in front, the sacroiliac ligaments rip in back, and the tough pelvic floor fascia tears apart: * By the mathematical law of the volume of a sphere (\(V = \frac{4}{3}\pi r^3\)), every small increase in the radius (\(r\)) of the pelvic ring increases its internal volume by the cube of the radius. * If the front of the pelvis opens by just 5 centimeters (2 inches), the internal volume of the pelvic cavity jumps by more than 400 percent. * Even worse, once the fascial floor of the pelvis tears, blood is no longer confined to the pelvis: it tracks freely upward behind the abdominal lining into the vast retroperitoneal space all the way up to the kidneys and diaphragm. The retroperitoneum can hold 4,000 to 5,000 milliliters (8 to 10 pints) of blood before pressure builds high enough to slow down the bleeding, meaning an adult will bleed to death long before self-tamponade ever occurs.

2. The Three Sources of Pelvic Hemorrhage (and why a binder stops two of them)¶

Where does all that blood come from inside a broken pelvis? 1. The Presacral and Prevesical Venous Plexus (80% to 85% of cases): A dense, cobweb-like network of large, thin-walled, valveless veins plastered directly against the front of the sacrum and behind the pubic bone. When the sacrum or pubic bone cracks, hundreds of these veins are shredded simultaneously. 2. Spongy Cancellous Bone Marrow Surfaces: The flat iliac wings and sacrum are filled with vascular red bone marrow; the raw broken bone surfaces ooze briskly like a wet sponge. 3. Internal Iliac Artery Branches (10% to 15% of cases): High-pressure arterial tears (most commonly the superior gluteal artery where it hooks around the greater sciatic notch, or the internal pudendal and obturator arteries). * How a Pelvic Binder works: Wrapping a tight circumferential binder around the greater trochanters mechanically closes the split pelvic ring back to its normal small radius (restoring the retroperitoneal tamponade compartment), presses the raw bleeding bone surfaces directly against each other to stop marrow oozing, and splints the bone fragments so they cannot move and tear the venous clots during ambulance transport.

How to recognize a pelvic fracture without ever rocking the hips¶

Why "Pelvic Springing / Rocking" is strictly forbidden¶

For decades, old first aid textbooks taught rescuers to place their hands on both hip crests and push forcibly downward and outward ("rocking or springing the pelvis") to feel for grating bone (crepitus) or instability. Modern trauma guidelines (ATLS, PHTLS, CoTCCC, NICE, JRCALC) strictly forbid pelvic springing: * Manually pushing an unstable pelvic ring apart has sensitivity below 60 percent, causes excruciating pain, and actively kills patients by popping off the newly formed fibrin blood clots covering the torn sacral venous plexus. * Even in the hospital trauma bay, if a paramedic has already placed a pelvic binder based on the crash mechanism, trauma surgeons leave the binder closed until a CT scan or pelvic X-ray is taken.

Six safe, hands-off clues that point to a pelvic fracture¶

1. High-Energy Mechanism + Unexplained Shock: Any victim of a high-speed car crash, motorcycle crash, pedestrian strike, horse accident, crush injury, or fall from > 3 meters (10 feet) who has a rapid heart rate (tachycardia > 100 bpm), pale clammy skin, or confusion must be assumed to have a pelvic fracture until proven otherwise.
2. Pain Location (in conscious patients): Spontaneous pain in the hips, groin, pubic area, lower back (sacrum), or buttocks, or inability to lift either leg off the ground.
3. External Rotation or Shortening of the Lower Extremities: Look down at the victim's feet while they lie on their back. In an open-book pelvic fracture, one or both legs flop outward so the outer edge of the foot rests against the ground (external rotation). In a vertical shear fracture (or posterior hip dislocation), one leg looks 2 to 5 centimeters (1 to 2 inches) shorter than the other.
4. Urogenital and Perineal Signs (50% of severe pelvic fractures injure the bladder or urethra):
5. A drop of bright red blood at the tip of the penis or urethral opening (blood at the urethral meatus).
6. Dark purple bruising and swelling of the scrotum, labia, or perineum (Destot's sign).
7. Vaginal bleeding or rectal bleeding (which indicates an open pelvic fracture where a sharp pubic bone shard has punctured the vagina or rectum, carrying a catastrophic risk of both exsanguination and polymicrobial pelvic sepsis).
8. Retroperitoneal Flank Bruising: Bluish-purple bruising appearing along the flanks (Grey Turner's sign) or above the inguinal ligament (Fox's sign).
9. Gentle Single-Touch Palpation (Only if conscious and diagnosis is completely uncertain): If a conscious patient has a minor mechanism and you are unsure if the pelvis is injured, you may gently feel the front pubic bone and back of the hips with flat fingers to ask if it is tender, and if you ever perform a single stability check in a clinical setting, you only gently press inward (compressing toward the midline) once at the trochanters, NEVER pushing outward or downward.

Step-by-step technique: Applying a Commercial Pelvic Binder or Improvised Bedsheet Binder¶

Step 1: Prepare the patient and empty all pockets¶

1. Keep the patient lying completely flat on their back (supine).
2. Empty all pockets and remove belts: Before wrapping anything tightly around the hips, use trauma shears to cut away or empty everything inside the front, side, and back trouser pockets (smartphones, keys, thick wallets, coins, belt buckles, or tools). Tightening a pelvic binder over a set of keys or a phone in a pocket will drive the metal object into the skin over the bone, causing a full-thickness necrotic pressure ulcer within 60 minutes.

Step 2: Find the exact anatomical landmark: The Greater Trochanters¶

To find the greater trochanters on any patient: 1. Do not feel at the waist or the top curved rim of the hip bone (that is the iliac crest, which is 10 to 15 centimeters / 4 to 6 inches too high). 2. Instead, slide your gloved hands down the outside of the patient's upper thighs to the level of the pubic bone (crotch) in front and the widest part of the buttocks in back. You will feel a hard, knobby bony prominence on the outer side of each upper femur: that is the greater trochanter. 3. The center line of your pelvic binder or folded sheet must pass directly across both greater trochanters and across the pubic symphysis.

Step 3A: Applying a Commercial Pelvic Binder (SAM Pelvic Sling II, T-POD, or Prometheus)¶

1. Slide under the knees first (No-Lift Technique): Fold the binder flat and slide it through the natural hollow gap underneath the patient's knees (never lift or log-roll the pelvis).
2. Seesaw upward into position: Holding one end of the binder on each side of the patient, use a gentle side-to-side sawing motion to slide the binder smoothly up beneath the thighs and lower buttocks until it is centered directly over the greater trochanters.
3. Internally rotate the legs: Have a second rescuer hold the patient's ankles and gently bring the legs together while rotating the feet inward ("pigeon-toed").
4. Pull and lock:
5. For a SAM Pelvic Sling, pull the black strap firmly through the Autostop buckle while pulling the opposite handle in the counter-direction until the buckle clicks and the two steel prongs lock into the perforations (designed to lock automatically at exactly 150 Newtons / 33 pounds of circumferential tension so you cannot over-compress the pelvis), then press the Velcro strap down.
6. For a T-POD, trim the belt leaving a 15-to-20-centimeter (6-to-8-inch) gap over the front of the pelvis, attach the mechanical pulley system across the gap, and pull the drawcord until the gap narrows and the pelvis is snug, then lock the cord.

Step 3B: Applying an Improvised Bedsheet Pelvic Binder (When no commercial device is available)¶

A strong cotton bedsheet, wide drawsheet, or blanket folded smoothly is clinically proven to reduce pelvic volume just as effectively as a commercial binder if applied at the trochanters: 1. Fold the sheet smoothly: Fold a flat bedsheet lengthwise until it forms a smooth, wrinkle-free band roughly 15 to 20 centimeters (6 to 8 inches) wide. 2. Slide under the knees and seesaw up to the Greater Trochanters: Pass the folded sheet beneath the hollow of the knees and slide it carefully up beneath the buttocks until it is centered over the greater trochanters and pubic symphysis. 3. Bring the legs together in internal rotation: Have a helper hold the knees and ankles together with the toes pointed slightly inward. 4. Cross, pull firmly, and secure: * Cross the two long ends of the sheet over the front of the pubic symphysis. * With one rescuer on the left and one on the right, lean back and pull both ends of the sheet smoothly and firmly in opposite directions until the slack is taken up and the sheet snugly hugs the trochanters. * Secure the sheet without losing tension: Either twist the two crossed ends together over the front of the pelvis and clamp them with heavy trauma clamps/hemostats (or twist them around a short stick/baton and tape the stick down, or tie a flat Reef/Square knot over a folded towel pad so the knot does not dig into the belly).

Step 4: Tie the Knees and Ankles in Internal Rotation ("The Figure-of-Eight Leg Tie")¶

Even with a binder around the hips, the heavy weight of two unconscious legs flopping outward acts as a mechanical lever that tries to pry the pubic symphysis back open. 1. Place a folded towel, jacket, or foam pad between the patient's knees and between their ankles to prevent bone-on-bone skin pressure sores. 2. Wrap a triangular cravat bandage, roller bandage, or wide strap around both knees, and wrap a figure-of-eight bandage around both ankles and feet to hold the legs comfortably rotated inward.

Step 5: Safe Lifting, Warming, and Transport Rules¶

1. Never log-roll a pelvic fracture patient: When paramedics arrive to move the patient onto a stretcher, they will use an orthopedic scoop stretcher (which splits in half lengthwise and slides under the left and right sides with minimal movement) or a 4-to-6-person vertical bridge lift.
2. Never remove or loosen a pelvic binder prematurely: Once a pelvic binder is applied, it stays locked in place until the patient is inside a hospital trauma center with blood transfusion running and orthopedic/interventional radiology teams ready. Loosening a pelvic binder in the field to "check the skin" lets the pelvic ring spring back open and triggers immediate re-bleeding.
3. Aggressive warming: Cover the patient completely with warm blankets and an insulating barrier underneath them to prevent the Lethal Trauma Triad (hypothermia, acidosis, and coagulopathy).

Special clinical scenarios in pelvic trauma¶

1. Open Pelvic Fractures and Perineal / Rectal / Vaginal Lacerations¶

Roughly 5 percent of pelvic ring fractures are open pelvic fractures, in which a razor-sharp fragment of the pubic rami or ischium slices through the skin of the groin, perineum, buttocks, vagina, or rectum. Open pelvic fractures carry a mortality rate approaching 40 to 50 percent because external skin tamponade is lost and fecal bacteria contaminate the retroperitoneal hematoma: * Never pull apart the legs or hips to inspect a perineal wound if it means opening the pelvic ring. * Control external groin or perineal bleeding with firm direct pressure and hemostatic gauze wound packing (or a junctional inguinal compression device if available), then apply the circumferential pelvic binder over the greater trochanters right over the packed wound dressing. * Never insert a urinary catheter, rectal thermometer, or vaginal pack in the field if blood is visible at the urethral meatus or perineum, as the urethra or rectum may be partially transected.

2. Pelvic Fractures in Pregnancy and in Children¶

• During Pregnancy: In the second and third trimesters, the gravid uterus rises out of the bony pelvis into the abdomen, and maternal uterine blood flow reaches 600 to 800 milliliters per minute. You can and should still apply a pelvic binder to an unstable pelvic fracture in a pregnant patient because the binder sits low over the greater trochanters and pubic symphysis (below the main fundus of the uterus). After applying the trochanteric binder, manually displace the pregnant uterus 15 to 20 degrees to the LEFT (or tilt the rigid scoop stretcher 15 to 30 degrees to the left) so the heavy uterus does not crush the maternal inferior vena cava (supine hypotensive syndrome).
• In Children: Pediatric pelvic bones are flexible and lined with thick cartilage, so it takes extreme kinetic energy (such as being run over by a vehicle) to break a child's pelvic ring. Fold a smaller sheet or pediatric binder to match the width of the child's trochanters and monitor closely for concurrent spleen or liver hemorrhage.

3. Prehospital Handoff Checklist for EMS and Trauma Resuscitation¶

• Mechanism of injury: High-speed crash, motorcycle fuel-tank impact, fall height, or crush weight.
• Ixesha elichanekileyo kunye nenqanaba le-anatomical yokubekwa kwesibophelelo: Qinisekisa ukuba isibophelelo sisembindini phezu kwe-i-trochanters ezinkulu kwaye iipokotho ziye zakhutshwa phambi kokuba kuqiniswe.
• Isimo se-Distal neurovascular (PMS) kwiinyawo zombini: I-Dorsalis pedis kunye ne-posterior tibial pulses, ukufudumala kwesikhumba, kunye nokunyakaza kweenyawo ngaphambi nangemva kokubopha.
• Iimpawu ze-Urogenital ziphawulwe: Ubukho begazi kwincam ye-urethral, ​​i-scrotal/labial hematoma, okanye imitya kwi-perineal.

Ukwazi indlela yokuqonda ukwaphuka kwe-pelvic efihliweyo kunye nokusebenzisa isibophelelo se-trochanteric kuguqula ukopha okubulalayo kwangaphakathi kube kukwenzakala okunokusinda. Cinga ukuthatha uncedo lokuqala oluqinisekisiweyo, Misa i-Bleed, okanye ikhosi ye-prehospital trauma ngokusebenzisa i-Red Cross okanye i-Red Crescent yoluntu, i-St John Ambulance, okanye i-National Association of Emergency Medical Technicians (NAEMT).

Imibuzo edla ngokubuzwa¶

Imithombo ijongiwe¶

• ** I-American College of Surgeons (i-ACS, eUnited States): ** * INkxaso yoBomi beNkxaso ePhambili (ATLS) Incwadi yeSifundo soMfundi: I-Abdominal and Pelvic Trauma, Circumferential Pelvic Compression, kunye ne-Hemorrhagic Shock *.
• Ikomiti ye-Tactical Combat Casualty Care (CoTCCC / Joint Trauma System, eUnited States): Izikhokelo zeTCCC kuBasebenzi bezoNyango: Iimpawu zePelvic Binder kunye nokubekwa kweTrochanteric.
• Iziko leSizwe lezeMpilo kunye neNkathalelo eGqwesileyo (i-NICE, e-United Kingdom): *Isikhokelo NG37: I-Trauma enkulu kunye ne-Complex Fractures, i-Prehospital Application ye-Pelvic Binders, kunye ne-Non-Log-Roll Handling *.
• IKomiti yoNxibelelwano lwee-Ambulance zeeKholeji zaseRoyal (JRCALC, eUnited Kingdom): *Izikhokelo zokuSebenza kweKlinikhi: Uvavanyo lwe-Pelvic Trauma ("Akukho Mthetho we-Springing") kunye ne-Pelvic Splinting *.
• UMbutho weHlabathi woTyando oluNgxamisekileyo (WSES, International): UHlelo lwe-Pelvic Trauma kunye neziKhokelo zoLawulo.

Izikhokelo ezinxulumeneyo¶

• Ukuqaphela ukothuka kunye nokhathalelo olungxamisekileyo
• Ukulimala komqolo kunye nokungakwazi ukuhamba
• Open (compound) fractures and splinting
• Ukukhutshwa kwesisu kunye nokunakekelwa kwenxeba elivulekileyo lesisu
• Crush injury and compartment syndrome recognition
• Amanani kaxakeka kunye nokuthunyelwa kwamanye amazwe