RA II General restorations

Define fracture

broken bone that is classified as simple or compound.

Define splint

An appliance of wood, metal or other suitable material used to protect or immobilize a moveable part.

Broken bones are classified as either:

Simple or Compound

What type of fracture is it where the broken bone does not pierce the skin?

Simple fracture

Describe the treatment for simple fractures

• Minor simple fractures require no restorative treatment

• Severe simple fractures may be require major restorative attempts including pre and post-embalming treatment, especially for head and face fractures.

What type of fracture is it where the broken bone has torn through the skin?

Compound fracture

Both simple and compound fractures can assume a variety of distortions

True

Describe an over-riding fracture

The bone margins overlap

Describe an depressed fracture

The bone margins are dented inward and the overlying surface area lacks support and normal surface contour/projection.

Describe multiple fractures

Two or more breaks have occurred in the same and/or different surrounding bones. “Crushed”

What is the best way to treat multiple fractures?

Best treated from inside the cranium and face via available orifices (oral, nasal, buccal, lacerations).

• If cranial autopsy was not performed and you must open the cranium, this is “major restoration,” and written permission needs to be obtained.

What is the general embalming treatment for broken bones?

• Remove packing materials and repack with clean, dry material

• Dry and seal incisions or breaks

• You may need to “hold” the bone with wire and/or replace missing sections with wood, plastic or metal pieces.

• Splints can be used as well on non-viewable areas to provide support to the fractured bone.

What is the restorative treatment for broken bones?

When normal appearance is distorted, post-embalming techniques include:

• Manipulate the broken bone until it comes back together. “Set” the bone.

• Build up sunken areas from within the cranial, buccal or nasal cavities using cotton, putty, etc.

How should you embalm severed limbs?

• Embalm the severed, or avulsed, limb separately using vessels if intact or hypodermically if no vessels are usable.

• Ligate and tie off vessels

• Dry and seal exposed tissue

• Suture the muscles of both parts tightly together, followed by the skin.

• Seal suture, cover with cotton once dry, and apply a second coat of sealer.

• Place in plastics.

Define avulsion

The tearing away or separation of a part of the body, resulting from an accident (or surgery).

How should missing limbs be handled if a limb is completed missing or partially missing restoratively?

• Use a dowel rod or splint to “replace” the entire or partial limb

• Insert rod into exposed area of the limb(s) and suture with a bridge suture to hold the dowel in place if possible.

• Cover with roll cotton and sealer.

• Tape with adhesive or duct tape, going 4-5 inches onto the skin to ensure proper replacement and secure hold of the prosthetic limb.

• Cover in plastics.

How should a missing hand be handled restoratively?

• A glove can be stuffed and attached to dowel or splint to represent a gloved hand.

• Pin the wrist end of the glove inside the sleeve to attach.

• Position the “arm and hand”

• A hand can be modeled with wax and placed under the natural hand. (Advise family or take other precautions!!!)

What is decapitation?

Separation (avulsion) of the head from the body

How should you embalm a decapitation?

• Inject the head and torso separately.

• For the head, the common carotids, if intact, are the best option.

• If missing, try the external and internal carotids or the external maxillary arteries.

• If no vessels are available hypo-inject and/or surface treat the head.

What is the restorative treatment for decapitation?

To securely rejoin, and properly align, the head and trunk:

• Obtain 3 dowels (wood, plastic, metal), about 8-12 inches in length, preferably with sharp/pointed ends.

• Insert 1 dowel into the spinal canal of the torso and then place the head upon the dowel, inserting it into the foramen magnum (achieve a proper “fit”).

• Insert remaining 2 rods into muscles on the lateral sides of the neck and secure dowels with wire and/or sutures.

• Suture muscle and deep tissue around entire circumference of the neck, filling missing tissue with mastic compound or cotton and sealer.

• Suture the skin together using an intradermal stitch if exposed or baseball stitch if unexposed.

• Seal, wax, add texture and cosmetize as needed if exposed.

• Seal, wrap securely with plastic and adhesive tape and/or bandage for additional support if unexposed (covered by clothing – the best/easiest option).