CHAPTER ONE

1.1 Historical development of student industrial work experience scheme

S.I.W.E.S was established by I.T.F in 1973 to solve the problem of lack of adequate

practical skills preparatory for employment in industries by Nigerian graduates of

tertiary institutions. The scheme exposes students to industry based skills necessary

for a smooth transition from the classroom to the world of work. It affords students

of tertiary institutions the opportunity of being familiarized and exposed to the

needed experience in handling machinery and equipment which are usually not

available in the educational institutions. Participation in S.I.W.E.S has become a

necessary pre-condition for the award of diploma and degree certificates in specific

disciplines in most institutions of higher learning in the country, in accordance with

the education policy of government operators- the I.T.F, the co-coordinating

agencies (N.U.C, N.C.C.E, and N.B.T.E), employers of labor and the institutions.

FUNDING- the federal government of Nigeria

BENEFICIARIES- undergraduate students of the following: agriculture,

engineering, technology, environmental, science, education, medical science and

pure and applied sciences.

DURATION- four months for polytechnics and colleges of education, and six

months for the universities three months short industrial trailing program. Highlight

number of presumed participating institutions:

Universities 65
1
Polytechnics 85

Colleges of education 62

Total 206

The number of students participating in S.IW.E.S from universities, polytechnics

and colleges of education averages at about 194,890 annually.

1.2 Objectives of the industrial training

TRAINING: the ultimate goal of the training is to accelerate the integration into

professional careers once the graduate is hired for the doing a certain task. This can

be achieved through many activities or objectives:

i. To expose students to building construction experience and knowledge

ii. To apply the building construction knowledge taught in lecture rooms in real

industrial situations

iii. To use the experience gained from industrial training in discussions held in the

lecture rooms.

iv. To get a feel of the work environment

v. To gain experience in writing work reports in construction works or projects.

vi. To expose students to the building construction responsibilities and ethics

vii. To expose the students to future employers as well as to introduce the

industrial training program available within the Federal University of Technology

Owerri

2
viii. With all the experience and knowledge acquired, it is hoped that the students

will be able to choose appropriate work upon graduation.

3
 CHAPTER TWO

2.1 About the Hospital

Cedarcrest Hospitals is a modern specialist medical care centre located in the heart

of Abuja; Nigeria. It was founded January 2008 with the aim of providing a high

standard healthcare service to the patient within and outside Nigeria. The centre

started off as a highly specialized orthopaedic facility, registered as Cedarcrest

Orthopaedic Clinics Ltd. Before long, it became obvious that other specialties had

to be incorporated partly due to the success of the centre and partly due to the lack

of local specialist services in those specialties that relate directly with orthopaedic

and trauma surgery. The hospital also offers specialist services covering internal

medicine, obstetrics and gynaecology, radiology, rheumatology, ear nose and throat

surgery, dietetics, physiotherapy and general practice. These key specialists are

supported by highly trained and courteous doctors, nurses, imaging scientists,

laboratory scientists, administrative and ancillary staff who strive to make patients

experience at Cedarcrest is as pleasant as possible. We work in liaison with centres

in the United Kingdom and the United States and frequently have visiting surgeons

from these foreign hospitals.

4
2.2 Clinic organogram

5
 CHAPTER THREE

2.1 Bone grafting

Bone grafting is a surgical procedure that replaces missing bone in order to repair

bone fractures that are extremely complex, pose a significant health risk to the

patient, or fail to heal properly. Some kind of small or acute fractures can be cured

but risky for large fractures like compound fractures.

Bone generally has the ability to regenerate completely but requires a very small

fracture space or some sort of scaffold to do so. Bone grafts may be autologous

(bone harvested from the patient’s own body, often from the iliac crest), allograft

(cadaveric bone usually obtained from a bone bank), or synthetic (often made of

hydroxyapatite or other naturally occurring and biocompatible substances) with

similar mechanical properties to bone. Most bone grafts are expected to be

reabsorbed and replaced as the natural bone heals over a few months’ time.

The principles involved in successful bone grafts include

2. osteoinduction (encouraging undifferentiated cells to become active osteoblasts),

3. osteogenesis (living bone cells in the graft material contribute to bone

remodeling).

Osteogenesis only occurs with autograft tissue and allograft cellular bone matrices.

2.2 Biological mechanism

Properties of various types of bone graft sources.

Osteoconductive Osteoinductive Osteogenic

Alloplast + – –

Xenograft + – –

Allograft + +/– –

Autograft + + +

Bone grafting is possible because bone tissue, unlike most other

2.3 Method

Depending on where the bone graft is needed, a different doctor may be requested

to do the surgery. Doctors that do bone graft procedures are commonly orthopedic

surgeons, otolaryngology head and neck surgeon, neurosurgeons, craniofacial

surgeons, oral and maxillofacial surgeons, podiatric surgeons and periodontists,

dental surgeons, oral surgeons and implantologists.

7
 AUTOGRAFT

Fig2.1: Illustration of an Autograft harvested from iliac crest

Autologous (or autogenous) bone grafting involves utilizing bone obtained from the

same individual receiving the graft. Bone can be harvested from non-essential

bones, such as from the iliac crest, or more commonly in oral and maxillofacial

surgery, from the mandibular symphysis (chin area) or anterior mandibular ramus

(the coronoid process); this is particularly true for block grafts, in which a small

block of bone is placed whole in the area being grafted. When a block graft will be

performed, autogenous bone is the most preferred because there is less risk of the

graft rejection because the graft originated from the patient's own body. As

8
indicated in the chart above, such a graft would be osteoinductive and osteogenic,

as well as osteoconductive. A negative aspect of autologous grafts is that an

additional surgical site is required, in effect adding another potential location for

post-operative pain and complications.

Autologous bone is typically harvested from intra-oral sources as the chin or extra-

oral sources as the iliac crest, the fibula, the ribs, the mandible and even parts of the

skull.

All bone requires a blood supply in the transplanted site. Depending on where the

transplant site is and the size of the graft, an additional blood supply may be

required. For these types of grafts, extraction of the part of the periosteum and

accompanying blood vessels along with donor bone is required. This kind of graft is

known as a vital bone graft.

An autograft may also be performed without a solid bony structure, for example

using bone reamed from the anterior superior iliac spine. In this case there is an

osteoinductive and osteogenic action, however there is no osteoconductive action,

as there is no solid bony structure.

Chin offers a large amount of cortico-cancellous autograft and easy access among

all the intraoral sites. It can be easily harvested in the office settings under local

anaesthesia on an outpatient basis. Proximity of the donor and recipient sites reduce

operative time and cost. Convenient surgical access, low morbidity, elimination of

9
hospital stay, minimal donor site discomfort and avoidance of cutaneous scars are

the added advantages.

A bone autograft

2.2 Growth factors

Growth Factor enhanced grafts are produced using recombinant DNA technology.

They consist of either Human Growth Factors or Morphogens (Bone Morphogenic

Proteins in conjunction with a carrier medium, such as collagen).

2.2.1 Recovery and aftercare

The time it takes for an individual to recover depends on the severity of the injury

being treated and lasts anywhere from two weeks to two months, with a possibility

of vigorous exercise being barred for up to six month.

10
2.3 Exercise physiology

Cyclists are known for using knowledge in exercise physiology in order to optimize

training to reach the maximal level of performance.

Exercise physiology:

Is the physiology of physical exercise. It is the study of the acute responses and

chronic adaptations to a wide range of exercise conditions.

Exercise physiologists study the effect of exercise on pathology, and the

mechanisms by which exercise can reduce or reverse disease progression.

2.4 Rapid energy sources

Energy needed to perform short lasting, high intensity bursts of activity is derived

from anaerobic metabolism within the cytosol of muscle cells, as opposed to

aerobic respiration which utilizes oxygen, is sustainable, and occurs in the

mitochondria. The quick energy sources consist of the phosphocreatine (PCr)

system, fast glycolysis, and adenylate kinase. All of these systems re-synthesize

adenosine triphosphate (ATP), which is the universal energy source in all cells. The

most rapid source, but the most readily depleted of the above sources is the PCr

system which utilizes the enzyme creatine kinase. This enzyme catalyzes a reaction

that combines phosphocreatine and adenosine diphosphate (ADP) into ATP and

creatine. This resource is short lasting because oxygen is required for the

resynthesis of phosphocreatine via mitochondrial creatine kinase. Therefore, under

anaerobic conditions, this substrate is finite and only lasts between approximately
11
10 to 30 seconds of high intensity work. Fast glycolysis, however, can function for

approximately 2 minutes prior to fatigue, and predominately uses intracellular

glycogen as a substrate. Glycogen is broken down rapidly via glycogen

phosphorylase into individual glucose units during intense exercise. Glucose is then

oxidized to pyruvate and under anaerobic condition is reduced to lactic acid. This

reaction oxidizes NADH to NAD, thereby releasing a hydrogen ion, promoting

acidosis. For this reason, fast glycolysis can not be sustained for long periods of

time. Lastly, adenylate kinase catalyzes a reaction by which 2 ADP are combined to

form ATP and adenosine monophosphate (AMP). This reaction takes place during

low energy situations such as extreme exercise or conditions of hypoxia, but is not a

significant source of energy. The creation of AMP resulting from this reaction

stimulates AMP-activated protein kinase (AMP kinase) which is the energy sensor

of the cell. After sensing low energy conditions, AMP kinase stimulates various

other intracellular enzymes geared towards increasing energy supply and decreasing

all anabolic, or energy requiring, cell functions.

2.5 Fatigue

Intense activity

Researchers once attributed fatigue to a build-up of lactic acid in muscles.

However, this is no longer believed.Rather; lactate may stop muscle fatigue by

keeping muscles fully responding to nerve signals. The available oxygen and

12
energy supply, and disturbances of muscle ion homeostasis are the main factor

determining exercise performance, at least during brief very intense exercise.

Each muscle contraction involves an action potential that activates voltage sensors,

and so releases Ca2+ ions from the muscle fibre’ssarcoplasmic reticulum. The action

potentials that cause this require also ion changes: Na influxes during the

depolarization phase and K effluxes for the repolarization phase. Cl− ions also

diffuse into the sarcoplasm to aid the repolarization phase. During intense muscle

contraction, the ion pumps that maintain homeostasis of these ions are inactivated

and this (with other ion related disruption) causes ionic disturbances. This causes

cellular membrane depolarization, inexcitability, and so muscle weakness.

2.6 Education in exercise physiology

Accreditation programs exist with professional bodies in most developed countries,

ensuring the quality and consistency of education. In Canada, one may obtain the

professional certification title – Certified Exercise Physiologist for those working

with clients (both clinical and non clinical) in the health and fitness industry. An

exercise physiologist's area of study may include but is not limited to biochemistry,

bioenergetics, cardiopulmonary function, hematology, biomechanics, skeletal

muscle physiology, neuroendocrine function, and central and peripheral nervous

system function. Furthermore, exercise physiologists range from basic scientists, to

clinical researchers, to clinicians, to sports trainers.

13
Colleges and universities offer exercise physiology as a program of study on

various different levels, including undergraduate, graduate, and doctoral programs.

The basis of Exercise Physiology as a major is to prepare students for a career in

field of health sciences. A program that focuses on the scientific study of the

physiological processes involved in physical or motor activity, including

sensorimotor interactions, response mechanisms, and the effects of injury, disease,

and disability. Careers available with a degree in Exercise Physiology can include:

non-clinical, client-based work; strength and conditioning specialists;

cardiopulmonary treatment; and clinical-based research.

In order to gauge the multiple areas of study, students are taught processes in which

to follow on a client-based level. Practical and lecture teachings are instructed in the

classroom and in a laboratory setting. These include:

 Health and risk assessment: In order to safely work with a client on the

job, you must first be able to know the benefits and risks associated with physical

activity. Examples of this include knowing specific injuries the body can experience

during exercise, how to properly screen a client before their training begins, and

what factors to look for that may inhibit their performance.

 Exercise testing: Coordinating exercise tests in order to measure body

compositions, cardiorespiratory fitness, muscular strength/endurance, and

flexibility. Functional tests are also used in order to gain understanding on a more

specific part of the body. Once the information is gathered about a client, exercise
14
physiologists must also be able to interpret the test data and decide what health-

related outcomes have been discovered.

 Exercise prescription: Forming training programs that best meet an

individuals health and fitness goals. Must be able to take into account different

types of exercises, the reasons/goal for a clients workout, and pre-screened

assessments. Knowing how to prescribe exercises for special considerations and

populations is also required. These may include age differences, pregnancy, joint

diseases, obesity, pulmonary disease, etc

2.7 Physical medicine and rehabilitation

2.8 Physical medicine and rehabilitation,

Is also known as physiatry, is a branch of medicine that aims to enhance and restore

functional ability and quality of life to those with physical impairments or

disabilities. A physician having completed training in this field may be referred to

15
as a physiatrist. Physiatrists specialize in restoring optimal function to people with

injuries to the muscles, bones, ligaments, or nervous system,

2.8.1 Treatment

The major concern that physical medicine and rehabilitation addresses is the ability

of a person to function optimally within the limitations placed upon them by a

disabling impairment or disease process for which there is no known cure. The

emphasis is not on the full restoration to the premorbid level of function, but rather

the optimization of the quality of life for those not able to achieve full restoration. A

team approach to chronic conditions is emphasized to coordinate care of patients.

Comprehensive Rehabilitation is provided by specialists in this field, who act as

facilitators, team leaders, and medical experts for rehabilitation.

In rehabilitation, goal setting is often used by the clinical care team to provide the

team and the person undergoing rehabilitation for an acquired disability a direction

to work towards. Very low quality evidence indicates that goal setting may lead to a

higher quality of life for the person with the disability, and it not clear if goal setting

used in this context reduces or increases re-hospitalization or death.[3]

2.8.2 Training

In the United States, residency training for physical medicine and rehabilitation is

four years long, including an intern year. There are 80 programs in the United

States accredited by the Accreditation Council for Graduate Medical Education, in

28 states.
16
2.9 Foot and ankle surgery

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with

the treatment, diagnosis and prevention of disorders of the foot and ankle.

Orthopaedic surgeons are medically qualified, having been through four years of

college, followed by 4 years of medical school to obtain an M.D. followed by

specialist training as a resident in orthopaedics, and only then do they sub-specialise

in foot and ankle surgery.

2.9.1 Clinical scope

Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both

surgical and non-surgical. Additionally, the surgeons are also trained to understand

the complex connections between disorders and deformities of the foot, ankle, knee,

hip, and the spine. Therefore, the surgeon will typically see cases that vary from

trauma (such as malleolar fractures, tibial pilon fractures, calcaneus fractures,

navicular and midfoot injuries and metatarsal and phalangeal fractures.) Arthritis
17
care (primarily surgical) of the ankle joint and the joints of the hindfoot (tarsals),

midfoot (metatarsals) and forefoot (phalanges) also plays a rather significant role.

Congentital and acquired deformalities include adult acquired flatfoot, non-

neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several

common pediatric foot and ankle conditions (such as clubfoot, flat feet, tarsal

coalitions, etc.) Patients may also be referred to a foot and ankle surgeon for proper

diagnosis and treatment of heel pain (such as a consequence from plantar heel

fasciitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot

and ankle. Amputation and ankle arthroscopy (the use of a laparoscope in foot and

ankle surgical procedures) have emerged as prominent tools in foot and ankle care.

In addition, more applications for laser surgery are being found in the treatment of

foot and ankle disorders, including treatment for bunions

2.9.2 Non-surgical treatments

18
The vast majority of foot and ankle conditions do not require surgical intervention.

For example, several phalangeal conditions may be traced to the type of foot box

used in a shoe, and a change of a shoe or shoe box may be sufficient to treat the

condition. For inflammatory processes such as rheumatoid arthritis, non-steroidal

anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs

(DMARDS) may be used to manage or slow down the process. Orthotics, or an

externally applied device used to modify the structural or functional characteristics

of the neuromusculoskeletal system specifically for the foot and ankle, may be used

as inserts into shoes to displace regions of the foot for more balanced, comfortable

or therapeutic placements of the foot. Physical therapy may also be used to alleviate

symptoms, strengthening muscles such as the gastrocnemius muscle (which in turn

will pull on the heel, which will then pull on the plantar fascia, thus changing the

structure and shape of the foot).

2.9.3 Surgical treatments

Anterior and lateral view x-rays of fractured left leg with internal fixation after

surgery

2.10 Arthroscopy

Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally

invasivesurgical procedure on a joint in which an examination and sometimes

treatment of damage is performed using an arthroscope, an endoscope that is

performed during ACL reconstruction. While commonly used for meniscal injuries

to the knee, this use is not supported by any evidence for its claimed positive

results.

The advantage over traditional open surgery is that the joint does not have to be

opened up fully. For knee arthroscopy only two small incisions are made, one for

the arthroscope and one for the surgical instruments to be used in the knee cavity.

This reduces recovery time and may increase the rate of success due to less trauma

to the connective tissue. It is has gained popularity due to evidence of faster

recovery times with less scarring, because of the smaller incisions. Irrigation fluid

(most commonly 'normal' saline) is used to distend the joint and make a surgical

space.

The surgical instruments are smaller than traditional instruments. Surgeons view the

joint area on a video monitor, and can diagnose and repair torn joint tissue, such as

ligaments. It is technically possible to do an arthroscopic examination of almost

every joint, but is most commonly used for the knee, shoulder, elbow, wrist, ankle,

foot, and hip.

2.9.1 Types

Knee arthroscopy: this has in many cases replaced the classic open surgery

(arthrotomy) that was performed in the past. Arthroscopic knee surgery is one of

the most common orthopaedic procedures, performed approximately 2 million

meniscus injury and to perform anterior cruciate ligament reconstruction.

During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is

inserted into the joint through a small incision, about 4 mm (1/8 inch) long. More

incisions might be performed in order to visually check other parts of the knee and

to insert the miniature instruments that are used to perform surgical procedures.

2.10 Osteoarthritis

The BMJ Rapid Recommendations group makes a strong recommendation against

arthroscopy for osteoarthritis on the basis that there is high quality evidence that

there is no lasting benefit and less than 15% of people have a small short-term

benefit. There are rare but serious adverse effects that can occur, including venous

thromboembolism, infections, and nerve damage The BMJ Rapid Recommendation

includes infographics and shared decision making tools to facilitate a conversation

between doctors and patients about the risks and benefits of arthroscopic surgery.

Two major trials of arthroscopic surgery for osteoarthritis of the knee found no

benefit for these surgeries.Many medical insurance providers are now reluctant to

reimburse surgeons and hospitals for what can be considered a procedure which

seems to create the risks of surgery with questionable or no demonstrable benefit.

However this is still a widely adopted treatment for a range of conditions associated

with osteoarthritis, including labral tears, femoroacetabular impingement,

osteochondritis dissecans.
21
A 2017 meta-analysis confirmed that there is only a very small and usually

unimportant reduction in pain and improvement in function at 3 months (e.g. an

average pain reduction of approximately 5 on a scale from 0 to 100). [6] A separate

review found that most people would consider a reduction in pain of approximately

12 on the same 0 to 100 scale important—suggesting that for most people, the pain

reduction at 3 months is not important. Arthroscopy did not reduce pain or improve

function or quality of life at one year.There is important adverse effects.

2.11 Meniscal tears

One of the primary reasons for performing arthroscopies is to repair or trim a

painful and torn or damaged meniscus.The technical terms for the surgery is

arthroscopic partial meniscectomy (APM). Arthroscopic surgery, however, does not

appear to result in benefits to adults when performed for knee pain in patients with

osteoarthritis who have a meniscal tear. This may be due to the fact that a torn

meniscus may often not cause pain and symptoms, which may be caused by the

osteoarthritis alone.

Some groups have made a strong recommendation against arthroscopic partial

meniscectomy in nearly all patients, stating that the only group of patients who may

- or may not - benefit are those with a true locked knee. Professional knee societies,

however, highlight other symptoms and related factors they believe are important,

and continue to support limited use of arthroscopic partial meniscectomy in

carefully selected patients.

Hip arthroscopy was initially used for the diagnosis of unexplained hip pain, but is

now widely used in the treatment of conditions both in and outside the hip joint.

The most common indication currently is for the treatment of femoroacetabular

impingement (FAI) and its associated pathologies. Hip conditions that may be

treated arthroscopically also includes labral tears, loose / foreign body removal, hip

washout (for infection) or biopsy, chondral (cartilage) lesions, osteochondritis

dissecans, ligamentum teres injuries (and reconstruction), Iliopsoas tendinopathy

(or ‘snapping psoas’), trochanteric pain syndrome, snapping iliotibial band,

osteoarthritis (controversial), sciatic nerve compression (piriformis syndrome),

ischiofemoral impingement and direct assessment of hip replacement.

2.13 Shoulder

23
Arthroscopy is commonly used for treatment of diseases of the shoulder including

subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears,

frozen shoulder (adhesive capsulitis), chronic tendonitis, removal of loose bodies

and partial tears of the long biceps tendon, SLAP lesions and shoulder instability.

The most common indications include subacromial decompression, bankarts lesion

repair and rotator cuff repair. All these procedures were done by opening the joint

through big incisions before the advent of arthroscopy. Arthroscopic shoulder

surgeries have gained momentum in the past decade. "Keyhole surgery" of the

shoulder as it is popularly known has reduced inpatient time and rehabilitation

requirements and is often a daycare procedure.

2.14 Spine

Many invasive spine procedures involve the removal of bone, muscle, and

ligaments to access and treat problematic areas. In some cases, thoracic (mid-spine)

conditions requires a surgeon to access the problem area through the rib cage,

dramatically lengthening recovery time.

Arthroscopic (also endoscopic spinal procedures) allow access to and treatment of

spinal conditions with minimal damage to surrounding tissues. Recovery times are

greatly reduced due to the relatively small size of incision(s), and many patients are

treated as outpatients. Recovery rates and times vary according to condition severity

and the patient's overall health.

Arthroscopic procedures treat

 spinal deformity

 tumors

 general spine trauma

2.14.1 Temporomandibular joint

Arthroscopy of the temporomandibular joint is sometimes used as either a

diagnostic procedure for symptoms and signs related to these joints, or as a

therapeutic measure in conditions like temporomandibular joint dysfunction. TMJ

arthroscopy can be a purely diagnostic procedure, or it can have its own beneficial

effects which may result from washing out of the joint during the procedure,

thought to remove debris and inflammatory mediators, and may enable a displaced

disc to return to its correct position.

25
Arthroscopy is also used to visualize the inside of the joint during certain surgical

procedures involving the articular disc or the articular surfaces, similar to

laparoscopy. Examples include release of adhesions (e.g., by blunt dissection or

with a laser) or release of the disc. Biopsies or disc reduction can also be carried out

during arthroscopy. It is carried out under general anesthetic.

2.15 Joint replacement

Replacement arthroplasty: this is a procedure of orthopedic surgery in which an

arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis.

Joint replacement is considered as a treatment when severe joint pain or dysfunction

is not alleviated by less-invasive therapies. It is a form of arthroplasty, and is often

indicated from various joint diseases, including osteoarthritis and rheumatoid

arthritis.

Joint replacement surgery is becoming more common with knees and hips replaced

most often. About 773,000 Americans had a hip or

Shoulder Joints

There are a few major approaches to access the shoulder joint. The first is the

deltopectoral approach, which saves the deltoid, but requires the supraspinatus to be

cut. The second is the transdeltoid approach, which provides a straight on approach

at the glenoid. However, during this approach the deltoid is put at risk for potential

damage. Both techniques are used, depending on the surgeon's preferences

26
Hip

Hip replacement can be performed as a total replacement or a hemi (half)

replacement. A total hip replacement consists of replacing both the acetabulum and

the femoral head while hemiarthroplasty generally only replaces the femoral head.

Hip replacement is currently the most common orthopaedic operation, though

patient satisfaction short- and long-term varies widely.

Knee

Knee replacement involves exposure of the front of the knee, with detachment of

part of the quadriceps muscle (vastus medialis) from the patella. The patella is

displaced to one side of the joint, allowing exposure of the distal end of the femur

and the proximal end of the tibia. The ends of these bones are then accurately cut to

shape using cutting guides oriented to the long axis of the bones. The cartilages and

27
the anterior cruciate ligament are removed; the posterior cruciate ligament may also

be removed[4] but the tibial and fibular collateral ligaments are preserved. Metal

components are then impacted onto the bone or fixed using polymethylmethacrylate

(PMMA) cement. Alternative techniques exist that affix the implant without

cement. This cement-less techniques may involve osseointegration, including

porous metal prostheses.

The operation typically involves substantial postoperative pain, and includes

vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and

may involve the use of mobility aids (e.g. walking frames, canes, crutches) to

enable the patient's return to preoperative mobility.

Ankle

Ankle replacement is becoming the treatment of choice for patients requiring

arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones.

The restoration of range of motion is the key feature in favor of ankle replacement

with respect to arthrodesis. However, clinical evidence of the superiority of the

former has only been demonstrated for particular isolated implant designs.

28
Finger

Finger joint replacement

Finger joint replacement is a relatively quick procedure of about 30 minutes, but

requires several months of subsequent therapy.

The Stress of the operation may result in medical problems of varying incidence

and severity.

 Heart Attack

 Stroke

 Venous Thromboembolism
29
 Pneumonia

 Increased confusion

 Urinary Tract Infection (UTI)

A patient in the Hospital with a broken bone issue

2.16 Orthopedic cast

An orthopedic cast, or simply cast, is a shell, frequently made from plaster or

fiberglass, encasing a limb (or, in some cases, large portions of the body) to

stabilize and hold anatomical structures, most often a broken bone (or bones), in

place until healing is confirmed. It is similar in function to a splint.

paris, which hardens after it has been made wet. Plaster of Paris is calcinedgypsum

(roasted gypsum), ground to a fine powder by milling. When water is added, the

more soluble form of calcium sulfate returns to the relatively insoluble form, and

heat is produced.

2 (CaSO4·½ H2O) + 3 H2O → 2 (CaSO4.2H2O) + Heat

The setting of unmodified plaster starts about 10 minutes after mixing and is

complete in about 45 minutes; however, the cast is not fully dry for 72 hours.

Nowadays bandages of synthetic materials are often used, often knitted fiberglass

bandages impregnated with polyurethane, sometimes bandages of thermoplastic.

These are lighter and dry much faster than plaster bandages. However, plaster can

be more easily moulded to make a snug and therefore more comfortable fit. In

addition, plaster is much smoother and does not snag clothing or abrade the skin.

Cotton and plaster casting material, (plaster cast) 4ply

Due to the nature of the dressing in that the limb is unreachable during treatment;

the skin under the plaster becomes dry and scaly because the discarded outer skin

cells are not washed or brushed off. Also, plaster of Paris casts can result in

cutaneous complications including macerations, ulcerations, infections, rashes,

itching, burns, and allergic contact dermatitis, which may also be due to the

presence of formaldehyde within the plaster bandages. In hot weather,

31
staphylococcal infection of the hair follicles and sweat glands can lead to severe and

painful dermatitis.

Other limitations of plaster casts include their weight, which can be quite

considerable, thus restricting movement, especially of a child. Removal of the cast

requires destroying the cast itself. The process is often noisy, making use of a

special oscillating saw that can easily cut the hard cast material but has difficulty

cutting soft material like cast padding or skin. Although the removal is often

painless, this can be distressing for the patient, especially children. A cast saw can

cut, abrade, or burn skin, but those results are uncommon.Additionally, plaster of

Paris casts break down if patients get them wet.

Due to the limitations of plaster of Paris, surgeons have also experimented with

other types of materials for use as splints. An early plastic like material was gutta-

percha obtained from the latex of trees found in Malaya. It resembled rubber, but

contained more resins. When dry it was hard and inelastic, but when warmed it

became soft and malleable. In 1851 Utterhoeven, described the use of splints made

from this material for the treatment of fractures. In the 1970s, the development of

fibreglass casting tape made it possible to produce a cast that was lighter and more

durable than the traditional plaster cast and also resistant to water (although the

bandages underneath were not) allowing the patient to be more active.

In the 1990s the introduction of new cast lining has meant that fiberglass casts with

this liner are completely waterproof, allowing patients to bathe, shower, and swim
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while wearing a cast. The waterproof cast liner however adds approximately 2 to 3

more minutes to the application time of the cast and increases the cost of the cast.

Drying time, however, can be inconvenient enough to warrant a cast and bandage

moisture protector. These waterproof covers allow for bathing and showering while

wearing either a plaster or fiberglass cast. The waterproof cast cover stays tightly

around the cast and prevents water from ever reaching it while the patient is in

contact with water. The cover can easily be removed to dry, and can be re-used

often.

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 CHAPTER FOUR

4.1 Conclusion

My industrial training work at Cedarcrest Hospitals, Lagos State was a success. I

can say that it has so many relations to my field of study like the knowledge of

isomers, ties of reaction, rates of reaction because the production of plastic products

is an exotericreaction and also reversible.With the experienced had so far, I can say

I will like to venture into the production if the opportunity comes

4.2 Appreciation

I will also appreciate my school, Federal University of Technology, Owerri and the

Staff on my Amiable Department for an opportunity to have a chance to go for this

I.T programme.

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