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Enhanced Microsoft Office 2013 Illustrated

Computer Concepts Unit A: Understanding Essential Computer
Concepts
A Guide to this Instructor’s Manual:
We have designed this Instructor’s Manual to supplement and enhance your teaching experience through classroom
activities and a cohesive unit summary.
This document is organized chronologically, using the same heading in blue that you see in the textbook. Under each
heading you will find (in order): Lecture Notes that summarize the section, Figures and Boxes found in the section, if
any, Teacher Tips, Classroom Activities, and Lab Activities. Pay special attention to teaching tips, and activities geared
towards quizzing your students, enhancing their critical thinking skills, and encouraging experimentation within the
software.
In addition to this Instructor’s Manual, our Instructor’s Resources Site also contains PowerPoint Presentations, Test
Banks, and other supplements to aid in your teaching experience.
For your students:

Our latest online feature, CourseCasts, is a library of weekly podcasts designed to keep your students up to date
with the latest in technology news. Direct your students to http://coursecasts.course.com, where they can
download the most recent CourseCast onto their mp3 player. Ken Baldauf, host of CourseCasts, is a faculty
member of the Florida State University Computer Science Department, where he is responsible for teaching
technology classes to thousands of FSU students each year. Ken is an expert in the latest technology and sorts
through and aggregates the most pertinent news and information for CourseCasts so your students can spend their
time enjoying technology, rather than trying to figure it out. Open or close your lecture with a discussion based
on the latest CourseCast.
Table of Contents
Unit Objectives 2
Concepts 2: Recognize You Live and Work in the Digital World 2
Concepts 4: Distinguish Types of Computers 3
Concepts 6: Identify Computer System Components 4
Concepts 8: Compare Types of Memory 5
Concepts 10: Summarize Types of Storage Media 6
Concepts 12: Differentiate Between Input Devices 7
Concepts 14: Explain Output Devices 8
Concepts 16: Describe Data Communications 9
Concepts 18: Define Types of Networks 10
Concepts 20: Assess Security Threats 11
Concepts 22: Understand System Software 13
Concepts 24: Describe Types of Application Software 14
End of Chapter Material 15
Glossary 15
Computer Concepts Instructor’s Manual Page 2 of 18
Unit Objectives
Students will have mastered the material in Understanding Essential Computer Concepts Unit A when they can:
• Recognize they live and work in a digital Explain output devices
world Describe data communications
• Distinguish types of computers Define types of networks
• Identify computer system components Assess security threats
• Compare types of memory Understand system software
• Summarize types of storage media Describe types of application software
• Differentiate between input devices
Concepts 2: Recognize You Live and Work in the Digital World

LEARNING OUTCOMES
• Identify benefits of Internet connectivity
LECTURE NOTES
• Discuss how over the past 20 years, the Internet has become an indispensable tool for businesses and people’s
everyday needs.
• Review ways we use computers in our everyday lives including to search for information, to communicate with
others, to telecommute, and to use cloud computing.
• Ask students for concrete examples of how they use the Internet in their everyday lives.
FIGURES: A-1, A-2, A-3
BOXES
1. Quick Tip: Many computers come with a built-in camera and microphone for use in
videoconferencing.
2. Quick Tip: Some companies use a virtual private network (VPN) that allows users to log in from a
remote location and easily access documents or communicate with coworkers.
3. Clues to Use: How to be a good online citizen
It’s important to understand that your Internet activities can have lasting repercussions on your
work and life. For instance, while social networks such as Facebook and Twitter let you hang out
with our friends online, some employers are known to keep an eye on employee accounts.
Because the Web is an easy source of photos, illustrations, and text, may people assume this
content is free to copy and use in their own work. However, if you plan to use an item that you
didn’t personally create, it’s important to know that copyright laws may protect it. For help with
understanding copyright issues, and for sources of “public domain” content, visit Creative
Commons at creativecommons.org.
TEACHER TIP:
This unit has a lot of conceptual information. It is wise to take the time to go through each lesson and
make sure that students clearly understand the material. Having various computer components available
for them to use in “hands-on” exploration would be helpful and would break up the reading. Make sure
students have a firm grasp on the hardware material before moving on to the software; many
students are anxious to start “clicking” and will not grasp the basic computer concepts that they will need
as they move forward with application software.
© 2016 Cengage Learning®. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
CLASSROOM ACTIVITIES
1. Critical Thinking:
How have computers altered your life in the last few years? What differences do you see in the world
around you? Has it changed the way you shop? Has it changed the way you purchase groceries or
gasoline? Have computers altered the way you accomplish school assignments or retrieve information?
2. Quick Quiz:
1. A basic form of Internet communication which allows a person to send a message to
another person is called . (email, electronic mail)
2. A form of Internet communication that allows two-way transmission of audio and video
is called . (videoconferencing)
3. To help you find information on the Web, you use a(n) _, which is an
online tool that allows you to enter keywords into a search box. (search engine)
Concepts 4: Distinguish Types of Computers

LEARNING OUTCOMES
• Define a computer
• Distinguish types of computers
LECTURE NOTES
• Spend some time explaining that there are four basic types of computers: personal computers,
handheld computers, mainframe computers, and supercomputers. If possible, show examples of
these.
• Explain that these classifications are based on size, speed, and cost.
• Personal computers come in several forms including desktops, laptops, notebooks, tablets,
subnotebooks, and slate computers.
• Hand-held computers are small enough to fit in your hand with a variety of capabilities depending
on cost.
• A mainframe computer is larger and more powerful than a personal computer and can handle many
more users. It is typically used for centralized storage, processing, and data management.
• The supercomputer is the largest and fastest of all the computers and is used for high-volume
computing tasks.
BOXES
1. Quick Tip: In common usage, the term “PC” refers to personal computers running the Microsoft
Windows operating system. Computers sold by Apple run the Mac (short for “Macintosh”)
operating system, and are referred to as Macs.
2. Clues to Use: Computers are more personal than ever
Technology is constantly evolving and improving, which means that computer hardware becomes
smaller and more powerful. For example, today’s desktop PCs are far more powerful than the
mainframe computers of a few decades ago, and current handheld smartphones are more capable
than the first laptops. As the lines between types of devices become less distinct, consumers may
need fewer devices to accomplish their tasks.
TEACHER TIP:
If possible, provide catalogs that show various computers, such as desktop, laptop, tablet, and handheld.
Have students compare the descriptions of each device. Discuss when one type of computer might be
used over another type.
In what ways could you use a computer in your home? If you were going to buy a computer, what type
of computer would you buy: a desktop computer, a laptop, a tablet, or a hand-held computer? What
features would you look for?
2. Quick Quiz:
1. T/F: A laptop and a notebook computer are similar types of computers. (T) 2.
T/F: Tablets are considered handheld computers. (F)
Concepts 6: Identify Computer System Components

LEARNING OUTCOMES
• Define hardware and software
• Define motherboard and processor
• Define input and output
LECTURE NOTES
• Explain that a computer system consists of hardware and software.
• Explain that hardware refers to the physical components of a computer system, and that
these components are used for processing, input, and output.
• Explain that the term software refers to the intangible components of the computer system
such as the programs (or lists of instructions) that the computer needs to perform specific
tasks.
• Go over the definitions of data, processing, and commands.
FIGURES: A-7, A-8
BOXES
1. Clues to Use: About microprocessor speeds
How fast a computer can process instructions depends partially on the speed of the microprocessor.
Among other factors, the speed of the microprocessor is determined by its clock speed, word size,
and whether it is single or multicore. Clock speed is measured in megahertz (MHz), millions of
cycles per second, or in gigahertz (GHz), billions of cycles per second. Word size refers to the
number of bits—the smallest unit of information in a computer—that are processed at one time; for
example, a 32-bit processor processes 32 bits at a time. A computer with a large word size can
process faster than a computer with a small word size. PCs come with 32-bit or 64-bit processors.
Finally, a dual-core processor, one that has two processors on a single chip, can process information
up to twice as fast as a single-core processor, one with one processor on the chip. Likewise, a
quadcore processor, with four processors on a chip, processes information up to four times as fast as
a single-core processor.
TEACHER TIP:
If possible, use an old computer from which you can remove the cover and potentially the hardware
components to illustrate the computer's physical components (such as the motherboard and the
processor). Show what you mean by the peripheral devices.
1. Assign a Project:
Ask students to make a drawing of a computer they use frequently. Have them label the hardware
components they can see. Ask them to include any peripheral devices they use. Then have them make a
list of the software they use on the computer.
2. Quick Quiz:
1. T/F: Software refers to the physical components of a computer. (F)
2. T/F: The motherboard is a circuit board. (T)
3. T/F: Computers need peripheral devices to accomplish the input, output, and storage
functions. (T)
Concepts 8: Compare Types of Memory

LEARNING OUTCOMES
• Define memory
• Distinguish types of memory
LECTURE NOTES
• Review the five types of memory with students: RAM, cache memory, virtual memory, ROM, and
CMOS memory.
• Explain that the amount of RAM in a computer can usually be upgraded and that adding more
RAM is a cost-effective way to improve the performance of the computer.
FIGURE: A-9, A-10
BOXES
1. Quick Tip: When the computer is off, RAM is empty.
2. Quick Tip: You can often add more RAM to a computer by installing additional memory cards on
the motherboard. You cannot add ROM; it is permanently installed on the motherboard.
3. Clues to Use: Upgrading RAM
One of the easiest ways to make your computer run faster is to add more RAM. The more RAM a
computer has, the more instructions and data can be stored there. You can often add more RAM to a
computer by installing additional memory cards on the motherboard. Currently, you can buy from 512
MB to 16 GB RAM cards, and usually, you can add more than one card. Check your computer’s
specifications to see what size RAM cards the slots on your motherboard will accept. Note that if your
computer has a 32-bit processor, it can’t use more than 4 GB of RAM, even if the computer has places to
plug in more cards.
TEACHER TIP:
Use a container to demonstrate RAM and virtual memory. Fill the container with items, and then
remove some and put in others.
1. Class Discussion:
Refer to FIGURE A-9 on page Concepts 9, and ask students to explain in their own words why virtual
memory is slower than RAM.
2. Quick Quiz:
1. T/F: RAM is sometimes referred to as involatile memory. (F)
2. T/F: Cache memory is sometimes called CPU cache. (T)
3. T/F: The CMOS chip is activated after the boot process is complete. (F)
LAB ACTIVITY
Ask the students to find out how much RAM is on the computer they are using. To do this, right-click
My Computer, then click Properties on the shortcut menu. The amount of RAM appears on the General
tab.
Concepts 10: Summarize Types of Storage Media

LEARNING OUTCOMES
• Define storage media
• Distinguish types of storage media
LECTURE NOTES
• All of the data that is generated through your input or the computer's processing needs to be
stored in a fashion that can be retrieved later. This is done through various types of storage
devices and media.
• Point out that most computers have a hard disk drive inside the computer. The hard disk
drive is a type of magnetic stoage device.
• Point out that optical storage devices use laser technology to read and write data.
• Point out that CDs and DVDs are optical storage media. Most newer computers come with a
DVD writer capable of reading and writing DVDs and CDs.
• USB flash storage devices are small, fast, convenient ways to store data. Have students look
at FIGURE A-12 for a visual of a flash storage device.
FIGURES: A-11, A-12
BOXES
1. Quick Tip: Optical storage devices, such as CDs and DVDs, are much more durable than magnetic
storage media.
2. Quick Tip: There is only one way to insert a flash drive, so if you’re having problems inserting the
drive into the slot, turn the drive around and try again.
3. Clues to Use: Rewriting on optical storage
CDs that you buy with software or music already on them are CD-ROMs (compact disc read-only
memory)—you can read from them, but you cannot record additional data onto them. To store data on
a CD, you need to record it on a CD-R (compact disc recordable) or CD-RW (compact disc rewritable)
drive and a CD-R or CD-RW disc. On a CD-R, after the data is recorded, you cannot erase or modify it,
but you can add new data to the disc, as long as the disc has not been finalized. In contrast, you can
rerecord a CD-RW. Recordable DVD drives are also available. As with CDs, you can buy a DVD to
which you can record only once, or a rewritable DVD to which you can record and then re-record data.
Recordable DVDs come in two formats, DVD-R and DVD+R, and likewise re-recordable DVDs come in
two formats, DVD-RW and DVD+RW. DVD drives on new computers are capable of reading from and
writing to both -RW and +RW DVDs and CDs, as well as DVDs with two layers. BD-R are Blu-ray discs
that you can record to once, and BD-RE are Blu-ray discs that you can record to multiple times. You
need a Blu-ray drive to use Blu-ray discs.
Optical storage is more durable than magnetic storage. Why?
2. Quick Quiz:
1. The first standard optical storage device available for personal computers was the . (CD
(compact disc))
2. is similar to ROM except that it can be written to more than once. (Flash memory)
3. The most common type of magnetic storage media is the . (hard disk, hard disk drive)
Concepts 12: Differentiate Between Input Devices

LEARNING OUTCOMES
• Define input devices
• Identify various input devices
LECTURE NOTES
• Input devices (such as a keyboard, a mouse, or another pointing device) provide a method
for inputting data and commands.
• Use the figures in the lesson to show the various types of input devices.
• Point out that scanners and microphones are also input devices.
BOXES
1. Quick Tip: You may also be able to avoid repetitive motion injuries by taking frequent breaks from
computer work and stretching your hands, wrists, and arms.
2. Quick Tip: Tablets and smartphones typically feature a “virtual keyboard” for inputting text.
3. Clues to Use: Understanding assistive devices
Advances in computer accessibility mean that people with physical impairments or disabilities can use
computers. For example, people who cannot use their arms or hands instead can use foot, head, or eye
movements to control a specialized assistive device. Those with poor vision can use keyboards with
large keys, screen enlargers that increase the size of objects on the monitor, or screen readers that speak
on-screen content aloud. Brain-computer interface technology may soon allow you to control a
computer with your thoughts.
Look at the two keyboards shown in FIGURE A-13 on page Concepts 13. How are the keyboards
similar? How are they different? Which do you think would be helpful in lessening repetitive motion
injuries? Why?
Ask students to consider the far-reaching impact of assistive devices for people with physical challenges.
Computers can help some people with physical impairments live independently. Does this have any
impact on society as a whole? Does anyone know anyone who uses a computer with an assistive device?
Concepts 14: Explain Output Devices

LEARNING OUTCOMES
• Define output device
• Identify different output devices
LECTURE NOTES
• Output devices are those that enable you to view the results of your work and the
processing work of the computer.
• Typical output devices are monitors and printers.
• Most flat panel monitors use LCD technology. Some flat panel monitors use LEDs to provide
the backlight.
• The most commonly used printers are laser and inkjet.
• Explain to students that you will typically find laser printers in businesses due to their quick
and efficient, high-quality output.
• Speakers allow the user to hear sound from the computer.
FIGURES: A-16, A-17
BOXES
1. Clues to Use: About multifunction printers
A multifunction printer (MFP) saves office space by combining several devices into one. Most small
office/home office (SOHO) MFPs can print, scan, copy, and fax documents. Some MFPs also feature
camera card readers and photo printing; this allows the user to print photos quickly without first
loading them into a PC. MFPs can be made available to a network when connected to a computer or
server. Some MFPs can also connect to a network wirelessly.
TEACHER TIP:
Discuss the options available for screen size, resolution, and dot pitch that students should consider
when purchasing a monitor.
1. Quick Quiz:
1. What kind of backlighting is more energy efficient than ordinary backlighting? (C) a.
flat panel
b. LCD
c. LED
2. Which of the following expresses the number of pixels a monitor displays in width and
height? (A)
a. resolution
b. dot pitch
c. graphics card
3. Which of the following produces output by spraying ink onto paper? (B) a. laser printer
b. inkjet printer
c. dot-matrix printer
How much of a consideration should the difference in speed between laser and inkjet printers be when
purchasing a printer? Inkjet printers typically print 6-10 pages per minute, and a laser printer prints
from 20-30 (and more, depending on cost) pages per minute.
Concepts 16: Describe Data Communications

LEARNING OUTCOMES
• Define data communications terms
• Identify PC slots and ports
LECTURE NOTES
• In order for peripheral devices to be useful, they must have a way of transmitting data to the
microprocessor.
• Each device has a port and a cable that connects into the computer (either externally or internally).
• These ports, in turn, connect to a controller card that provides the electrical connection to the main
computer board.
• There are several types of ports available with microcomputers, including parallel, serial (including
USB), SCSI, MIDI and Ethernet.
• Each of type of port has different capabilities as far as data transmission, and each is designed to
work with different peripheral devices.
FIGURE: A-18
BOXES
1. Quick Tip: An internal peripheral device such as a hard disk drive may plug directly into the
motherboard, or it may have an attached controller card. 2. Clues to Use: How computers
represent and interpret data
A computer sees the world as a series of binary digits or bits. A bit can hold one of two numerical
values: 1 for “on” or 0 for “off.” You might think of bits as miniature light switches. Of course, a
single bit doesn’t hold much information, so eight of them are combined to form a byte, which can
be used to represent 256 values. Integer value 1 equals 00000001 (only 1 bit is “flipped” on), while
the byte that represents 255 is 11111111 (all the bits are flipped on). A kilobyte (KB or K) is 1024
bytes, or about a thousand bytes. A megabyte (MB) is 1,048,576 bytes (about a million bytes). A
gigabyte (GB) is about a billion bytes, and a terabyte (TB) is about a trillion bytes.
If you change or upgrade the operating system on a computer, why would you need to update the
device drivers?
2. Quick Quiz:
1. Ports connect to a inside the computer. (A)
a. controller card
b. cable
c. USB connector
2. Which of the following is a computer program that handles the transmission protocols
between a computer and a peripheral device? (B)
a. controller
b. device driver
c. USB connector
3. Rules that establish an orderly transfer of data between the sender and the receiver are called
. (A)
a. protocols
b. slots
c. drivers
LAB ACTIVITY
Examine the back of a computer and have the class work together to identify each of the ports.
Concepts 18: Define Types of Networks

LEARNING OUTCOMES
• Define networking terms
• Identify network types
LECTURE NOTES
• A network enables you to share data and resources with others.
• A typical network configuration is a local area network (LAN) where the computers and devices are
located relatively close to each other.
• If a computer is connected to a network, it is referred to as a workstation. Each workstation requires
a network interface card to create the communications channel between the network and the
computer.
• The computer workstation must also have network software to establish communications protocols.
• Each device on the network is referred to as a node.
• A wide area network (WAN) is a network of LANs.
• Wireless networking has grown in popularity over the past few years.
• Wi-Fi is used to connect computers to a LAN over a short distance.
• Personal area networks (PANs) are used to connect devices in close proximity to each other. They
typically use infrared and Bluetooth technology to communicate.
FIGURE: A-19
BOXES
1. Quick Tip: The World Wide Web is subset of the Internet, and is a huge database of information
stored on network servers.
2. Clues to Use: Understanding telecommunications
Telecommunications means communicating over a relatively long distance using a phone line or some
other data conduit. To make this connection, you must use a modem. A device that converts the digital
signals that your computer outputs into analog signals that can travel over ordinary phone lines or cable
lines. Many desktops and laptops come with a built-in 56K modem that can send and receive about
56,000 bits per second (bps) over a phone line. This is slow by modem standards, so many people opt for
a high-speed connection using DSL (digital subscriber line), which also operates over a phone line, or
using a cable connection. If you go this route, you may need to purchase or rent an external DSL or
cable modem. DSL and cable modems typically connect to a computer’s NIC (network interface card)
via an Ethernet cable. High-speed connections are often called broadband connections.
TEACHER TIP:
Explaining how the network students are using is set up may help clarify the terms used in this section.
It may also give students a better understanding of the systems on which they will work.
Building on the networking concepts developed in this lesson, explain to students that the Internet,
which was originally developed for the government to connect researchers around the world who
needed to share data, is now the largest network in the world.
Ask students to identify at least three networks at school. They should be able to describe them as
LANs, WANs, WLANs, or PANs.
LAB ACTIVITIES
1. Use a Web browser to search for and view the information available on any given topic or give a
specific location to find
2. Use an email program to demonstrate sending and receiving a message.

Concepts 20: Assess Security Threats
LEARNING OUTCOMES
• Define types of security threats
• Establish importance of good security
LECTURE NOTES
• Security refers to the steps a computer owner takes to prevent unauthorized use of or damage to a
computer.
• Malware is a broad term that describes any program that is intended to cause harm or convey
information to others without the owner’s permission.
• Antivirus software searches executable files for the sequences of characters that may cause harm
and disinfects the files by erasing or disabling those commands.
• Spyware tracks a computer user’s Internet usage and sends this data back to the company or person
that created it without the computer user’s permission or knowledge.
• Point out that adware is different than spyware—adware is installed on a computer with the user’s
permission.
• A firewall prevents other computers on the Internet from accessing a computer and prevents
programs on a computer from accessing the Internet without the computer user’s permission. A
firewall can be either hardware or software.
• Make students aware of the practices of spoofing and phishing.
• Pharming is less common because a hacker would need to hack directly into a DNS server.
FIGURES: A-20, A-21
BOXES
1. Quick Tip: Some specific types of viruses are called worms; another type is a Trojan horse. Antivirus
software usually protects against both types.
2. Quick Tip: Adware is software installed with another program usually with the user’s permission
that generates advertising revenue for the program’s creator by displaying ads.
3. Quick Tip: If you suspect you’ve received a phishing message, don’t click any links in the email.
Instead, open your browser and type the correct URL into the address bar.
4. Clues to Use: Protecting information with passwords
You can protect data on your computer by using passwords. You can set up accounts on your computer
for multiple users and require that all users sign in with a user name and password before they can use
it. This is known as logging in or logging on. You can also protect individual files on your computer so
anyone who tries to access a file must type a password. Many Web sites, especially e-commerce and
banking sites, require a user name and password to access the information stored there. To prevent
anyone from guessing your passwords, always create and use strong passwords. A strong password
consists of at least eight characters of upper- and lowercase letters and numbers. Avoid using easy to
obtain personal information in your passwords, such as birthdays and addresses, and always create
different passwords that are unique to each website you use.
TEACHER TIP:
Reinforce that one way to avoid being tricked into divulging personal information on a spoofed Web
site is to type URLs directly into a browser rather than clicking a URL sent in an e-mail message from a
company.
Discuss each of the “safe computing” practices listed in the lesson. How important is each one?
There are many brands of both commercial and free antivirus software packages. Have students find an
example of each and use the Web to research the ratings for the two they pick. Is there a reason to pick
one over the other?
Concepts 22: Understand System Software

LEARNING OUTCOMES
• Define system software
• Identify types of system software
LECTURE NOTES
• Discuss the fundamental operations of the computer that are managed by system software.
• There are four types of system software: operating systems, utility, device drivers, and programming
languages.
• Operating system software controls basic input and output, allocates system resources, manages
storage space, maintains security, and detects equipment failure.
• Utilities (another type of system software) aid the operating system by taking over some of its
responsibility for allocating hardware resources.
• A device driver is system software that aids the computer in communicating with individual
peripheral devices.
• Computer programming languages are the system software that programmers use to write computer
instructions.
• Many of the components of system software work hand-in-hand with each other to assist you in
accomplishing tasks.
• The Clues to Use, on page Concepts 23, discusses the hardware requirements for Windows 8,
Microsoft’s newest operating system.
FIGURES: A-22, A-23
BOXES
1. Quick Tip: As part of its security responsibility, your computer’s operating system may require you
to enter a username and password, or it may scan the computer to protect against viruses.
2. Clues to Use: Examining Windows 8 hardware requirements
Windows 8, the newest version of the Windows operating system, requires a computer with at least a 1
GHz processor, 1 GB of RAM for the 32-bit version or 2 GB of RAM for the 64-bit version, a DirectX 9
graphics processor, 128 MB of specialized graphics RAM, and 16 GB of available space for the 32-bit
version or 20 GB for the 64-bit version. Keep in mind that these are the minimum recommendations.
To prevent your computer from slowing to a crawl, you should consider upgrading the amount of RAM
and the processor speed.
1. Group Activity:
Students who have never used anything other than a GUI may not appreciate how easy GUIs make it to
accomplish specific tasks. Click the Start button, and then click Documents and demonstrate the various
ways to display the files and folders contained in the Documents folder. Next, open a command window
by clicking the Start button, clicking All Programs, clicking Accessories, and then clicking Command
Prompt. In the window, type cd Documents, press [Enter], type dir, and then press [Enter] again.
Compare this list to the open window. (Click the Close button to close the command window.)
2. Quick Quiz:
1. T/F: An operating system allocates system resources, manages storage space, maintains
security, detects equipment failure, and controls basic input and output. (T)
2. T/F: A system resource is a liaison between the user and all of the computer’s hardware and
software. (F)
3. T/F: D++ is an example of a popular programming language. (F)
Concepts 24: Describe Types of Application Software

LEARNING OUTCOMES
• Define application software
• Identify types of application software
LECTURE NOTES
• Spend an appropriate amount of time explaining application software.
• Some students may be familiar with some computer programs, but many in the class may not have a
clear understanding of these terms.
• Explain that application software, which is commonly referred to as computer programs, is the
software that enables you to perform specific tasks with your computer.
• Some typical tasks you can perform are creating documents and spreadsheets, managing databases,
and creating graphics and multimedia presentations.
• All of these applications have features and tools built into them that aid you in achieve the best
results for the project on which you are working.
FIGURES: A-24, A-25
BOXES
1. Quick Tip: To duplicate or move text, document production software allows you to perform
copyand-paste and cut-and-paste operations.
2. Quick Tip: In Excel, a workbook is a file made up of multiple worksheets. The terms
spreadsheet and worksheet are often used interchangeably.
TEACHER TIP:
Give some examples of application software, which students may be familiar with or may have, at least,
heard advertised or talked about by others (e.g., Microsoft Word, Adobe Photoshop). It will be helpful
for students who are not familiar with application software to have an in-class demonstration of a few
different types of applications with an explanation of what they can accomplish with each type.
Have students use the descriptions of application software on page Concepts 24 to decide which type of
computer program is best-suited to complete the following tasks:
• catalogue a music collection (database management)
• write a five-paragraph essay (document production)
• remove “red-eye” from a photograph (photo editing)
• create a To-Do list with due dates (information management)
• write a 40-page paper (document production)
• create a budget (spreadsheet)
End of Chapter Material

• Concepts Review – Includes screen identification, multiple choice, and matching questions.
• Independent Challenges 1, 2, and 3 – Provides additional hands-on exercises that mirror the
progressive style of the lesson material.
• Independent Challenge 4 – Provides an opportunity for students to explore a real world focus to
apply the unit skills, students create documents that will benefit their everyday lives.
Glossary of Key Terms • Bluetooth (Concepts 18)
• anti-spyware software (Concepts 20) • Blu-ray (Concepts 10)
• antivirus software (Concepts 20) • boot process (Concepts 8)
• application software (Concepts 24) • booting up (Concepts 8)
• architecture (Concepts 6) • bridging (Concepts 18)
• BD-R (Concepts 11) • broadband connections (Concepts 19)
• BD-RE (Concepts 11) • browser (Concepts 20)
• binary digits (Concepts 17) • built-in graphics card (Concepts 14)
• BIOS (basic input/output system) • byte (Concepts 17)
(Concepts 8) • cable (Concepts 16)
• bits (Concepts 17) • cache memory (Concepts 8)
• bits per second (bps) (Concepts 19) • cards (Concepts 6)
• CD (compact disc) (Concepts 10) (Concepts 24)
• CD-R (compact disc recordable) • dots per inch (dpi) (Concepts 14)
(Concepts 11) • driver (Concepts 16)
• CD-ROM compact disc read-only • DSL (digital subscriber line (Concepts
memory (Concepts 10) 19)
CD-RW (compact disc rewritable) • dual-core processor (Concepts 7)
(Concepts 11) • DVD (Concepts 10)
• Cells (Concepts 24) • DVD-R (Concepts 11)
• central processing unit (CPU) • DVD+R (Concepts 11)
(Concepts • DVD-RW (Concepts 11)
6) • DVD+RW (Concepts 11)
• channel (Concepts 16) • DVI (digital video interface)
• circuit board (Concepts 6) (Concepts
• circuits (Concepts 6) 16)
• client/server network (Concepts 18) • email (Concepts 2)
• clip art (Concepts 24) • ergonomic (Concepts 12)
• clock speed (Concepts 7) • Ethernet port (Concepts 16)
• commands (Concepts 6) • executable file (Concepts 10)
• complementary metal oxide • expansion card (Concepts 16)
semiconductor (CMOS) memory expansion port (Concepts 16)
(Concepts 8) • expansion slots (Concepts 16)
• computer (Concepts 4) • field (Concepts 24)
• computer accessibility (Concepts 13) • file (Concepts 10)
• computer system (Concepts 6) • firewall (Concepts 20)
• configuration (Concepts 6) • firmware(Concepts 8)
• controller card (Concepts 16) • firmware update (Concepts 8)
• CPU cache (Concepts 8) • flash drive (Concepts 10)
• CSS (Concepts 24) • flash memory (Concepts 10)
• data (Concepts 6) • flash memory cards (Concepts 10)
• data bus (Concepts 16) • flat panel monitor (Concepts 14)
• data communications (Concepts 16) • font (Concepts 24)
• data file (Concepts 10) • gigabyte (GB) (Concepts 17)
• database (Concepts 24) • gigahertz (GHz) (Concepts 7)
• database management software • graphical user interface (GUI)
(Concepts 24) (Concepts 22)
• desktop computer (Concepts 4) • graphics card (Concepts 14)
• device driver (Concepts 16) • graphics processor (Concepts 14)
• display (Concepts 14) • graphics software (Concepts 24)
• display resolution (Concepts 14) • handheld computers (Concepts 4)
• DNS server (Concepts 20) • hard copy (Concepts 14)
• document production software
• hard disk (Concepts 10) • MP3 players (Concepts 4)
• hardware (Concepts 6) • Multifunction printer (MFP)
• HDMI (high-definition multimedia (Concepts
interface) (Concepts 16) 15)
• headphones (Concepts 14) • multimedia authoring software
• HTML (Concepts 24) (Concepts 24)
• information management software • netbooks (Concepts 4)
(Concepts 24) • network interface card (NIC)
• infrared technology (Concepts 18) (Concepts
• inkjet printers (Concepts 14) 18)
• input (Concepts 6) • network software (Concepts 18)
• input and output (I/O) (Concepts 22) • node (Concepts 18)
• input device (Concepts 6) • nonvolatile memory (Concepts 8)
• interface card (Concepts 16) • notebook computer (Concepts 4)
• Internet (Concepts 18) • operating environments (Concepts 22)
• keyboard (Concepts 12) • operating system (Concepts 22)
• kilobyte (KB or K) (Concepts 17) • optical character recognition (OCR)
(Concepts 12)
• laptop computer (Concepts 4)
laser printers (Concepts 14) • optical storage devices (Concepts 10)
• LCD (liquid crystal display) (Concepts • output (Concepts 6)
14) • output devices (Concepts 6)
• LED (light emitting diode) (Concepts • pages per minute (ppm) (Concepts 14)
14) • peer-to-peer network (Concepts 18)
• LED printer (Concepts 14) • peripheral devices (Concepts 6)
• local area network (LAN) (Concepts • permanent memory (Concepts 8)
16) • personal area network (PAN)
• logging in (Concepts 21) (Concepts
• magnetic storage devices (Concepts 18)
10) • personal computers (Concepts 4)
• mainframe computers (Concepts 4) • pharming (Concepts 20)
• malware (Concepts 20) • phishing (Concepts 20)
• megabyte (MB) (Concepts 17) • photo editing software (Concepts 24)
• megahertz (MHz) (Concepts 7) • pixels (Concepts 14)
• memory (Concepts 8) • pointer (Concepts 12)
• memory capacity (Concepts 8) • pointing device (Concepts 12)
• microphone (Concepts 12) • presentation software (Concepts 24)
• microprocessor (Concepts 6) • printer (Concepts 14)
• modem (Concepts 16) • processing (Concepts 6)
• monitor (Concepts 14) • processor (Concepts 6)
• motherboard (Concepts 6) • programming languages (Concepts 22)
• mouse (Concepts 12) • programs (Concepts 6)
• protocols (Concepts 16) • telecommunications (Concepts 19)
• quad-core processor (Concepts 7) • temporary memory (Concepts 8)
• RAM cache (Concepts 8) • terabyte (TB) (Concepts 17)
• random access memory (RAM) • toner (Concepts 14)
(Concepts 8) • touch pad (Concepts 12)
• read-only memory (ROM) (Concepts • touch screen (Concepts 12)
8) • trackball (Concepts 12)
• receiver (Concepts 16) trackpad (Concepts 12)
• record (Concepts 24) • ultraportable computers (Concepts 4)
• router (Concepts 18) • URL (Concepts 20)
• scanner (Concepts 12) • USB (Universal Serial Bus) port
• screen (Concepts 14) (Concepts 16)
• screen size (Concepts 14) • USB connector (Concepts 16)
• scroll wheel (Concepts 12) • USB drive (Concepts 10)
• search engine (Concepts 2) • utility software (Concepts 22)
• security (Concepts 20) • VGA (video graphics array) (Concepts
• semipermanent memory (Concepts 8) 16)
• sender (Concepts 16) • video card (Concepts 14)
• servers (Concepts 18) • video display adapter (Concepts 14)
• single-core processor (Concepts 7) • video editing software (Concepts 24)
• slots (Concept 16) • videoconferencing (Concepts 2)
• smartphones (Concepts 4) • virtual memory (Concepts 8)
• software (Concepts 6) • virus protection software (Concepts
• solid-state drive (SSD) (Concepts 10) 20)
• solid state storage (Concepts 10) • viruses (Concepts 20)
• speakers (Concepts 14) • voice recognition software (Concepts
• specifications (Concepts 6) 12)
• spell checking (Concepts 24) • volatile memory (Concepts 8)
• spoofed (Concepts 20) • Web site creation and management
• spreadsheet software (Concepts 24) software (Concepts 24)
• spyware (Concepts 20) • wide area network (WAN) (Concepts
• stand-alone computer (Concepts 18) 18)
• strong password (Concepts 21) • Wi-Fi (short for wireless fidelity)
• subnotebook computers (Concepts 4) (Concepts 18)
supercomputers (Concepts 4) • wireless local area network (WLAN)
• synchronous dynamic random access (Concepts 18)
memory (SDRAM) (Concepts 8) • word size (Concepts 7)
• system resource (Concepts 22) • worksheet (Concepts 24)
system software (Concepts 22) • workstation (Concepts 18)
• Tablet (Concepts 4)
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Fig. 333 Fig. 334 Fig. 335
Fracture of upper end of Transverse fracture, with Line of fracture at junction
tibia. anterior displacement. of lower and middle thirds
(From the Buffalo of tibia.
Museum.)
While wire sutures may be used as freely as may be indicated it

will be well, at least in the majority of cases, to leave the ends
protruding in such a way that they can later be untwisted and
removed. The presence of wire after a certain length of time rather
interferes with the process of ossification than helps it.
Fractures of the lower end of the leg nearly always involve the
joint, to some extent at least, in respect of being accompanied by
sprain if nothing else. They are accompanied by displacement of the
foot, and are produced by violence, which first involves the foot. The
term “Pott’s fracture” is meant to include the injury originally
described by Pott himself. In the typical Pott’s fracture, as shown in
Figs. 336 and 337, there are a chipping off of the internal malleolus,
of the outer portion of the articular end of the tibia, and fracture of the
fibula a little above the joint. In spite of the classical description
which Pott gave fractures of the fibula alone, those accompanied by
tearing of the internal lateral ligament, or chipping off of the
malleolus, are frequently referred to under the same term. The more
complete the injury the greater the possibility for displacement.
Eversion and outward displacement, of course, are conspicuous.
Lesser degrees of injury are accompanied by less displacement, but
all of these injuries will be followed by extreme swelling of the ankle-
joint, which may at first make diagnosis somewhat difficult, because
of the extreme tenderness which prevents the handling necessary
for careful determination. It is not always easy to so completely
replace the bones, when we have the combination of three fractures
as above, as to get an ideal result. Nevertheless with suitable
treatment usually very useful limbs are secured. When the injury has
been made compound the difficulties are increased. Such a result
will not be obtained, however, unless the tendency to backward and
lateral displacement be overcome, when the limb is placed in its
permanent plaster-of-Paris splint, as it should be after a few days.
Great care should be given to this point in the management.
Fig. 336 Fig. 337
Pott’s fracture. (Hoffa.) Exaggerated deformity in Pott’s fracture.

—Nearly all these fractures
Treatment of Fractures of the Leg.are likely to be followed by
swelling, even to a degree which makes it impracticable to put them
up in permanent dressing until the swelling has subsided. This
means a period of two to several days, during which the limb should
be kept absolutely at rest, and the bones maintained in apposition by
side splints, while the limb is restrained within a folded pillow or other
comfortable cushion. More frequently here than in any other part of
the body there will form blebs or large blisters, which are most liable
to occur in alcoholic subjects. The leg should be scrubbed and
shaved before putting on dressings, in order that the skin may be
reasonably clean before its surface epithelium is raised. Ecchymosis,
infiltration, and sometimes general edema may become somewhat
pronounced, and the splint which would be required to fit a limb
under these circumstances would soon be too large when this
disturbance has subsided. The limb should not, therefore, be placed
in a fixed or permanent dressing until it is in every respect ready.
While these disturbances are subsiding, or perhaps being
encouraged to subside by the use of an ice-bag or of cold wet
applications, extreme care should be taken that proper position and
apposition are maintained. This will at times need considerable
ingenuity. A delirious or maniacal patient would need restraint far
beyond that required for one who is rational and docile. Moreover in
all of these fracture cases which entail confinement to bed there is a
tendency to deficiency of elimination which will require judicious use
of laxatives and other eliminatives.
The writer prefers a well-molded set of side splints, properly
padded, to any other first dressing for fractures of the leg. A limb
thus dressed may be supported on a pillow and even made
adaptable for transportation should it be necessary to remove the
patient from one place to another. The fracture box can be well
superseded by this method.
So soon as swelling has subsided, plaster of Paris should be used
for a fixed dressing. The limb should be enveloped in a layer of
cotton, by which the skin is protected, within which swelling may
occur without much strangulation. Over this and down the front of the
leg a strip of thick pasteboard should be placed, which can be
moistened and made to adapt itself, or a strip of sheet tin, an inch
wide, which can be made to fit the part, and upon which one may cut
down later in removing the splint. This refers especially to the use of
the roller bandage saturated with plaster of Paris. Molded splints can
be made, as recommended for the upper extremity, out of surgeons’
lint, canton flannel, or old blanketing, while at the lower end of these
splints may be incorporated, with the plaster, a strip of bandage or
other material, by which a loop is formed beneath the foot, which
may be utilized for the purpose of traction.
The foot should always be placed at a right angle to the leg. If
there be too much muscle spasm to permit this, or make it too
uncomfortable, the tendo Achillis may be divided. This position
should be maintained during the period of repair, in order that so
soon as one resumes the use of the limb the foot may be planted
naturally upon the ground. In addition to this precaution it must be
noted that backward displacement is completely overcome, and that
eversion is perhaps a trifle overcorrected.
In all fractures of the lower end of the leg the foot and entire leg
should be enclosed in a bandage. In fractures near or above the
middle not only the leg but the lower part of the thigh should be
immobilized if the promptest and most satisfactory results are to be
obtained.
The limb being immobilized it soon becomes a question as to how
quickly the patient can leave the bed and begin to move about on
crutches. This will depend to some extent on the patient’s
temperament. Timid women are less desirous of getting out of bed
than are active men and children. Some patients acquire facility with
crutches very slowly. Others are so tenderly built that crutches give
pain and even produce crutch paralysis. It is advisable to get
patients at least into the sitting posture so soon as the immobilization
has been secured, while those inclined may be encouraged to use
the uninjured limb and move about with crutches. A foot and leg too
long kept off the ground will swell when again lowered. The later this
dependent position is attained the greater the liability to edema.
Patients should be cautioned about this.
The so-called ambulatory method of treatment has found favor
with some surgeons. This implies something more than merely
permitting motion with crutches; it means really such dressing as to
permit use of the injured limb in locomotion. The various forms of
splints used for immobilizing the limb in hip-joint disease may be
used in this way. A useful splint is made with body and perineal
bands, or an inside steel bar with ischiatic crutch and a cross-bar
below the sole of the foot, on which the weight of the body may be
supported. This is to be combined with a plaster-of-Paris support.
The ambulatory treatment is occasionally of value, but the
advantages claimed for it have not been generally sustained.
FRACTURES OF THE FOOT.

The astragalus and the calcis suffer more often than the other
tarsal bones, partly because of their size and partly because they are
in the line of transmission of force as usually directed after accident.
When the posterior end of the calcis is broken off there remains a
fragment which is easily palpated, and which would be displaced
backward and upward by the tendo Achillis were it not for the plantar
fascial fibers which are inserted into it. The bone may also be
comminuted, in which case that part of the foot will lose much of its
shape and distinctive peculiarities. The sole will be flattened, but
swelling and hemorrhage will at first be so great that there will be
much difficulty in recognizing the exact nature of the injury.
The astragalus is usually broken by being caught between the
calcis and the lower end of the leg. It is generally broken through the
line of its so-called neck. Not infrequently one or more of the
fragments is forced out of place, usually beneath the anterior
tendons. When such extensive displacement occurs the fragments
should be removed if the fracture is compound. In both of these
bones results are generally satisfactory when displacement is not
marked, also after removal of the entire astragalus. The foot and leg
should be immobilized in the best possible position, and this can be
best accomplished within a plaster-of-Paris dressing.
In regard to the tarsal bones, diagnosis can now be made
accurately by the use of the x-rays. These bones, according to
Eisendrath, may be fractured in any one of the following ways: (1)
Compression, as when the weight of the body is violently thrown
upon the feet; (2) sudden dorsal flexion, often with fracture of the
inner malleolus; (3) forced supination or pronation, the interosseous
ligaments being stronger, the bones forcibly pulling the latter apart;
(4) violent traction upon the heel through the calf muscles, by which
the tuberosity of the calcis may be torn from the rest of the bone; (5)
extensive crushing injuries, in which several tarsal bones may be
involved; (6) gunshot fractures. Some assistance in diagnosis may
be obtained by computing the distance from the malleoli to the
bottom of the heel, which will be shortened when the bones are
compressed; or shortening of the length of the foot, or by fixed
abnormal positions.
The metatarsal bones are broken by direct violence, the first and
fifth being most exposed. As in other fractures of the foot contusion
will be a serious feature, and swelling and laceration will frequently
seriously complicate, while the fractures themselves may be
compound. The same is true, also, of fractures of the phalanges,
crushing and comminution being common. The matter of treatment
often includes an estimation of the blood supply and of the vitality of
the distal portion. The operator may sometimes temporize with an
antiseptic dressing until this matter is settled. Simple fractures
require only immobilization in good position.
C H A P T E R X X X V.
DISLOCATIONS.
A sprain has already been described as a momentary change of
emplacement or disturbance of the normal relations between joint
surfaces, which, so far as displacement is concerned, is but a
momentary affair and is promptly overcome. The term dislocation
implies something more permanent as well as complete in both
respects. It indicates an absolute and direct separation of articular
surfaces of much more than momentary duration and requiring
skilled assistance for its reduction. It pertains to articular surfaces
which are enclosed within a capsule. The term luxation is
synonymous with dislocation. When the condition is evidently partial
or incomplete it is often referred to as subluxation. As compared with
fracture dislocations are about one-tenth as frequent.
Dislocations are described as compound when through a co-
existing wound air may enter the cavity of the joint, and as
complicated when accompanied by other lacerations or injuries.
When unaccompanied by these conditions they are described as
simple.
To dislocations which result from external violence or from sudden
muscular action is given the term traumatic. Pathological dislocations
are those which are brought about by slow morbid processes,
muscle spasm being the most prominent factor in their production. A
third variety of dislocations, the so-called congenital, do not belong
strictly in this class; by common consent the term is applied to
congenital abnormalities where, from errors in development, normal
emplacements and relations are altered.
The distal bone is the one described as that which is dislocated;
thus we speak of dislocations of the forearm upon the arm, of the leg
upon the thigh, etc.
Subluxations or incomplete dislocations are frequently
accompanied by fracture of a bony prominence, e. g., the rim of the
acetabulum, the coronoid process of the ulna, etc. The direction in
which the distal member of the joint has been displaced is indicated
by one of the common terms, as forward, inward. A consecutive or
secondary dislocation implies a shifting of position from that at first
occupied by the displaced bone end. These injuries may occur at
any age, although usually during the more active period of life, from
childhood to middle age, when mankind are more subject to injuries.
Certain conditions predispose to dislocations. Abnormalities or
previous injury or disease of joint structures figure especially in this
respect. A joint already relaxed by hydrarthrosis will exercise a
relatively small restraining influence and a subluxation, at least, may
easily occur.
The immediate cause is violence, either from without or within,
generally the former. This may be direct, as from a blow, or
transmitted, as when the shoulder is displaced by a fall upon the
open hand. It occasionally happens that the component bones of a
dislocated joint were in a position of extreme flexion or extension at
the time of injury. The factors of leverage and spiral tension or
wrenching are also important ones. Luxation from muscular activity
is occasionally met with; most frequently when the lower jaw is
dislocated by the act of yawning or violent laughter. The shoulder
has been displaced in a violent effort at throwing or pitching a ball, or
in wild gesticulation.
A few individuals have been in the habit of exhibiting themselves
whose normal ligament and joint arrangements are so lax that they
can voluntarily displace one or more of them and as easily replace
them. These may be spoken of as instances of voluntary dislocation.
A joint once displaced may never fully recover its normal degree of
tension, and will yield more readily to subsequent similar injuries. In
this way there may occur so-called recurrent or habitual dislocations.
Expressions of this kind are seen most often in the lower jaw and in
the patella.
Actual injury to tissues is to some extent unavoidable. In arthrodial
joints the capsule is nearly always lacerated, at least upon one side.
In hinge joints both lateral ligaments are likely to be ruptured. It is
probable, however, that about the maxillary joints the ligaments may
stretch without tearing to any extent. Not only are ligaments torn, but
bony prominences are frequently detached, while sometimes there is
extensive tearing away of tissue.
In connection with these injuries to joints proper other
complications may occur, such as fractures of prominences about
joints and epiphyseal separations, or such injuries as compound
fracture of the neck of the humerus with dislocation of its head.
Furthermore, bloodvessels are occasionally lacerated and nerves
are frequently injured. This latter lesion is liable to occur after
shoulder dislocations, the head of the bone injuring the circumflex
nerve, paralysis of the deltoid being the consequence. This is a
feature of the injury, and yet the result has often been unjustly
imputed to the physician in attendance. Even a momentary
contusion of the nerve may be followed by lasting effects, for which
the medical attendant should be held blameless. Other injuries, e. g.,
contusions or lacerations of nerves, may occur about any of the
joints.
Dislocations of the spine subject the cord to a special class of
injuries which will be dealt with later in this work. In very rare
instances the head of the humerus has been forced within the thorax
or the head of the femur within the pelvis, these, injuries being
practically always fatal.
Compound dislocations rarely occur about the jaw or shoulder.
They pertain usually to the joints below. In every case of such
character the question will be promptly raised whether a more or less
complete exsection of the joint will not be preferable to mere
reduction with the ensuing probability of ankylosis. Such injuries will,
under all circumstances, require aseptic measures.
So far as repair is concerned, dislocations by themselves are so
rarely fatal that there have been but few opportunities for a study of
tissue recovery under these circumstances. It is apparent that repair
is complete, for after almost any simple dislocation there is
restoration of function.
The obstacles to reduction are spasm of muscles pertaining to the
injured limb, by which the dislocated bone end is firmly held in its
abnormal position, and, in those joints provided with a capsule, the
fact that the head of the bone is frequently forced out through a
comparatively small opening, through which it is only with the
greatest difficulty reduced. It is a part of the manipulation in most
cases to enlarge this rent in the capsule, after which reduction is
comparatively easy, although impossible until it is accomplished.
Dislocations which have long gone unreduced are called old,
inveterate, or ancient. By common consent a period of six weeks has
been fixed, beyond which the dislocation is spoken of as old or
ancient; up to that time it is usually described as unreduced. In
proportion to the length of this period the difficulties of reduction are
materially enhanced. So soon as a dislocated joint has been put at
rest, i. e., fixed by muscle spasm and by the timidity of the patient,
the blood which has been poured out will begin to coagulate and
conditions are soon favorable for organization of clot and formation
of adhesions in abnormal position. In the course of a few weeks
these adhesions become strong, and in the course of months they
are frequently stronger than the bone itself, which has been disused
and has undergone a certain amount of fatty atrophy. Thus it
happens that even with well-directed effort the bone will yield before
the adhesions, and thus, in spite of every precaution, fracture
sometimes complicates the effort to reduce these ancient
dislocations.
So generally is this fact now recognized that surgeons do not
hesitate to make open incisions for the purpose of separating
adhesions and reopening what remains of the capsule in the
endeavor to replace the head of a bone. Nor do they hesitate
sometimes to cut down upon the latter and exsect rather than run the
risk of more extensive injury.
Efforts at reduction under these circumstances subject the patient
not only to risk of failure, or of fracture of bone ends, but to rupture of
vessels or laceration of nerve trunks. I recall seeing one case of
enormous traumatic aneurysm of the axillary artery which was
brought about by unsuccessful attempt in this direction.
SYMPTOMS AND DIAGNOSIS OF DISLOCATIONS.

The cardinal indications of a dislocation are deformity with
alteration in contour and position of the affected joint. It usually
happens that the dislocated bone ends cannot be felt in normal
position, but are felt somewhere else in the vicinity. About the
shoulder and hip of stout or fat individuals it may not be easy to feel
the head of the bone, but unless the case be complicated by a
fracture it can usually be detected by aid of anesthesia. The
deformity may include a lengthening or shortening of the limb,
apparent or real, as well as abnormal eversion or inversion, or other
peculiarity of position.
Whatever alterations in position appear will be accentuated by
spasm of the muscles which pertain to the movement of the affected
joint or even of the entire limb. These are usually so tightly
contracted as to form a complicating feature of such cases and to
lead to that loss of mobility which is diagnostic of every dislocation.
Limitation of motion is not entirely a matter of muscle spasm. It is not
under voluntary control and subsides only under anesthesia. To
some extent motion may be limited by escape of the head of a bone
through a small rent in the enveloping capsule, by which it is
afterward tightly clasped. This is particularly true of the shoulder and
hip. Certain dislocations of the fingers or thumbs are also made
more rigid by fixation of the tendons, which become tightly stretched
within the neighboring tendon sheaths.
A sort of crepitus, which may be easily mistaken for that of
fracture, is occasionally detected during the examination of a
dislocated joint. It lacks the peculiar grating character of true bony
crepitus.
In addition to these features there are certain subjective
symptoms, of which loss of function is the most prominent, while
pain is a more or less frequent but variable accompaniment, and
dependent on the amount of tissue injury or pressure upon nerves.
Moreover, the displacement once completely rectified (“reduced”)
does not tend to recur, as is the case with fractures.
PATHOLOGICAL AND CONGENITAL LUXATIONS.

The statements made above refer almost entirely to recent and
traumatic dislocations.
Pathological dislocations are those which are produced gradually
and through the mechanism of disease affecting the joint structures.
The head of the bone is gradually drawn out of the acetabulum, in
tonic spasm of hip-joint disease, by the continuous action of
muscles, the result being the complete displacement of the bone
from its original socket, or what is known, at the hip, as the migration
of the acetabulum, where its upper margin, being softened by
disease, is gradually extended and altered, so that the femoral head
rests an inch or more higher upon the side of the pelvis than is
normal. Pathological dislocations, then, may occur both in the course
of the infectious joint diseases as well as in the neuropathic.
Congenital luxations are those which occur from defect in the
shape or arrangement of joint structures, permitting a departure from
the normal standard. While no joint in the body is exempt from
abnormalities of this description, the congenital hip dislocations are
those which have attracted attention by their frequency and the
disability which they produce.
While the general character of these changes is easily made out
by the ordinary methods of examination, coupled with a suitable
history, a well-made skiagram will tell at a glance a story which it
may take some effort to elicit by other means; hence radiography
has here been of great value to the surgeon. Congenital dislocations
are devoid of nearly all the features which characterize traumatic
dislocations, and their consideration will be found in the chapter on
Orthopedics.
Differential diagnosis as between fractures and dislocations is not
always easy. Furthermore it is frequently the separation of a
prominence by fracture which permits of dislocation, this being
particularly true of the elbow and the ankle. The extent of a fracture
may seriously complicate the problem of treatment, as, for instance,
when the head of the humerus is not only dislocated below the
clavicle but separated from the shaft by fracture at the surgical neck.
A dislocation made possible only by fracture will not remain reduced
as will one which is simple and uncomplicated, while it will display
even a greater amount of motility and displacement. Other
complications may occur, many of which are common both to
dislocations and to fractures in the vicinity of joints, such as
lacerations of bloodvessels or nerve trunks, pressure upon the latter,
compound injuries with infections, etc.
TREATMENT OF DISLOCATIONS.
The essential requisite of every case is complete reduction or
replacement of the dislocated bone end. The earlier this is attempted
the better the result. Brief as such a statement is, dislocations
frequently offer considerable difficulties, both in reduction and in
maintenance in proper position with the necessary physiological rest
of the injured part. Thus dislocations of the clavicle, which can hardly
occur without considerable injury to the ligaments, may be reduced
with slight effort, but are kept in place with difficulty. The simplicity of
the after-treatment is proportionate to the difficulty experienced in
reduction, so that while “to put the part in place and keep it there”
sounds very simple, it will often perplex the ingenuity of the surgeon.
Reduction having been effected, rest is the essential feature of the
after-treatment, which should be absolute for a few weeks and
relative for many months. Should reaction be extreme, ice-cold
applications will afford relief.
The causes which prevent reduction of dislocation are either those
attributable to ignorance, carelessness, or failure in diagnosis on one
hand, or, on the other, mechanical difficulties, including “button-
holing” of the capsule around the expanded end of a bone or the
interposition of some of the adjoining tissues. Dislocations of the
class referred to above as unreduced or ancient, offer great
difficulties, proportionate to their duration, which are due to the
formation of adhesions that sometimes take place and become very
dense. Judgment, skill, and effort are needed in their management.
A dislocation which has become unreducible is only to be treated by
arthrectomy and the establishment of a false joint. Nevertheless in a
small proportion of cases, especially of the hip and shoulder
dislocations, the adhesions which first form gradually relax, and in
time there is formed a natural substitute for a joint which may be
regarded as a nearthrosis, and which will sometimes prove as
serviceable as any result afforded by arthrectomy. The duration of
time after which reduction is impossible or impracticable varies so
widely with different cases that it can scarcely be stated. It rarely is
more than a few months and often but a few weeks. It is greater
when it is a ball-and-socket joint which is affected.
Nearly everything that has been stated in the previous chapter
concerning compound fractures applies here to compound
dislocations. They are subject to the same dangers, both of infection
and of injury to important adjoining structures. There is the same
necessity for aseptic management if the case be seen early, and for
antiseptic treatment, including drainage, if seen late. In many
instances there is so much liability to subsequent ankylosis that the
first treatment may well be made to include an arthrectomy, or the
total removal of a small bone, e. g., the astragalus. Fortunately
compound features are less frequent in dislocations than in
fractures.
SPECIAL DISLOCATIONS.
DISLOCATIONS OF THE LOWER JAW.

Unless accompanied by fracture there is but one direction in which
the condyle of the inferior maxilla can be dislocated, i. e., forward.
One side or both may be affected, i. e., dislocation may be unilateral
or bilateral, the latter being more frequent. It is rare during the
extremes of age, and most common during middle life. There is
considerable variation in the degree of tension of the capsule of the
maxillary joint. In some it is so loose that dislocation may occur
during the act of yawning or vomiting. Ordinarily it occurs only as an
expression of violence from without. By a blow which shall thrust the
jaw forward, whether the mouth be closed or open, the ramus may
be made to carry the condyle over the articular eminence. The
capsule is not necessarily torn, but is always tightly stretched, while
as a reflex result the temporal muscle is thrown into a condition of
tonic spasm by which the jaw is fixed and firmly held in its abnormal
position. This produces the symptoms, then, of a more or less widely
opened mouth, with rigidity and inability to close it, with protrusion of
the chin and tense contraction of the temporal muscle, which can be
easily recognized. When the dislocation is unilateral the symptoms
are essentially the same, save that the protrusion is toward the side
that is injured.
Treatment.—The method of reduction is simple and consists in
depressing the angle of the jaw, while, at the same
time, the chin is supported and carried both upward and backward. If
temporal spasm be not too pronounced the reduction is rather easy
and may be effected while the patient is seated in a chair, the
surgeon standing in front of him and grasping the jaw with the fingers
of each hand, while the thumb is utilized within the mouth to press
the angle of the jaw downward and backward. At the same time the
fingers should lift the chin. The operator should protect his thumbs
by wrapping them with some material in order that they may not be
injured by the patient’s teeth. Should muscle spasm offer much
resistance it would be well to administer nitrous oxide or one of the
other anesthetics, at least to the point of primary anesthesia, with
sufficient relaxation of muscle to make reduction easy. When once
this has been effected the lower jaw should be bound to the upper
and kept at rest for at least two weeks. When this injury has taken
place it is likely to recur with much less effort until it becomes almost
a habit.
Fig. 338 Fig. 339
Reduction of dislocation of lower jaw.

There is a condition of relaxation of the capsule and elongation,
with abnormal loosening of the interarticular fibrocartilage, peculiar to
this joint, by which it has too free play, to such an extent that a
clicking sound in its movements may be frequently heard by others
than the patient. This condition is either congenital or the result of
previous injury, and is one for which little can be done, although this
explanation should be afforded to all who suffer from it.
DISLOCATIONS OF THE LARYNX.

The cartilages of the larynx are sometimes displaced as the result
of direct violence applied to the anterior region of the neck. Almost
any lesion of this character may take place between the independent
cartilages of the larynx or the attachments of the larynx to the hyoid.
The injury may simply give rise to pain and soreness, or may cause
so much interior damage as to be quickly followed by edema of the
glottis and suffocation. If the latter be impending a quick tracheotomy
should be done, after which time may be afforded for such
replacement as may be required, by manipulation, and subsidence
of swelling with relief from occlusion of the respiratory tract.
DISLOCATIONS OF THE STERNUM.

The various portions of the sternum, especially the upper and the
lower, may be displaced as the result either of direct violence by
forcible backward flexion, or by muscular action accompanied by
flexion of the trunk and neck. When the latter, it is usually forward;
when produced by violence, it is usually backward.
These displacements are sometimes so easily reduced by mere
pressure as to make it almost impossible to retain them. At other
times anesthesia with firm pressure, accompanied by flexion of the
trunk backward or forward, may be required; reduction has been
possible sometimes only through incision and by the use of
instruments applied as levers, or by the use of a screw driven into
one of the fragments, thus affording a handle by which to manage it.
Serious dislocations are frequently accompanied by fractures of the
ribs or of the sternum. The same fixation of the thorax is required as
in fractures of these parts, and should be conducted in the simplest
manner possible.
DISLOCATIONS OF THE RIBS.

To displace a rib from its sternal connections requires actual
fracture of bone or cartilage. Forward dislocation at its posterior and
spinal connection, especially of the eleventh and twelfth ribs, has
been described. Considerable effort is necessary for its production,
and the case should be treated on its individual merits.
DISLOCATIONS OF THE CLAVICLE.

Either end or both ends of the clavicle may be dislocated. Its
sternal end may be thrown in any direction but downward; its
acromial end in any direction, although usually upward. Dislocations
of the sternal end can only occur in consequence of serious damage
to the sternoclavicular ligaments, because of which, and in the
absence of a socket, it is extremely difficult to maintain the parts
when restored to position. Violent backward traction upon the
shoulder permits anterior displacement when the joint is thus
weakened. Backward displacement is usually the result of indirect
violence when the shoulder is forced forward and inward, while
upward displacement is the result of tilting which occurs when the
shoulder is violently depressed. Respiration is generally more or less
disturbed, while in backward luxations deglutition may be made
difficult and painful.
Reduction is not difficult to effect, but extremely difficult to
maintain. Pressure in the proper direction, accompanied by traction
upon the shoulder, suffices for the former. For the latter there should
be a combination of fixation of the shoulder and arm with proper
traction, and at the same time pressure upon the end of the clavicle.
For all of the clavicular dislocations the dressing and position
advised by Dr. Moore, of Rochester, and referred to in the chapter on
Fractures as his double figure-of-eight, serves admirably for
maintaining the proper position of the shoulder, while pressure can
be made by a pad, retained either by adhesive plaster or by some
further addition to the dressing itself. (See p. 494.) Acromial
dislocation is usually in the upward direction, and is produced by
violence upon the shoulder, which has expended itself in rupturing
ligaments rather than in fracturing the acromion process. The
indication here is to keep the shoulder elevated by any dressing
which will accomplish the purpose and the clavicle bound down.
Fig. 340
Position of clavicle in dislocation of sternal end upward.
Dislocation of both ends, i. e., complete loosening of the bone,

occurs occasionally, in which case the indications already given are
reinforced, while the difficulties of treatment are considerably
aggravated. Here the shoulder should be kept upward, outward, and
backward, and the clavicle retained by pressure or some other
means.
Treatment.—Clavicular dislocations yield fair results to intelligent
treatment. Ideal results are difficult to secure without
coöperation on the part of the patient. Functional results, however,
are usually satisfactory.
DISLOCATIONS OF THE SHOULDER-JOINT.

The upper end of the humerus is attached to the margin of the
glenoid cavity by a capsule which has a certain degree of elasticity,
and which resembles a short section of a sleeve or a cuff. It is
sufficiently loose to permit a wide range of motion, and were it not for
the acromial process above it there would be as much motility in the
upward direction as in any other. It is not the capsule which keeps
the articular surfaces together, but the tension of the muscles which
are wrapped around the shoulder-joint, all of which contribute to this
effect. The glenoid cavity is made a more complete socket by a
fibrocartilaginous rim. Thus a certain degree of subluxation or
displacement may be permitted without very serious damage to this
rim and capsule, but a complete dislocation is hardly possible
without more or less laceration. The prominence and exposure of the
joint and its natural freedom of motion help to account for the fact
that more than half of all dislocations occur here, and that this rarely
ever occurs in children or in the aged, in whom the violence which
may be expanded produces either epiphyseal separations or
fractures of the surgical neck. The relation of structure to function
also accounts for their far greater frequency (i. e., four to one) in men
than in women. The influence of atmospheric pressure should not be
forgotten, as in the shoulder this affords a force of some fifty pounds,
and in the hip of nearly double that amount, of pressure.

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For your students:

Computer Concepts Instructor’s Manual Page 2 of 18

world Describe data communications

• Distinguish types of computers Define types of networks

• Identify computer system components Assess security threats

• Compare types of memory Understand system software

• Summarize types of storage media Describe types of application software

• Differentiate between input devices

Concepts 2: Recognize You Live and Work in the Digital World

FIGURES: A-1, A-2, A-3

Concepts 4: Distinguish Types of Computers

FIGURES: A-4, A-5, A-6

Concepts 6: Identify Computer System Components

FIGURES: A-7, A-8

Concepts 8: Compare Types of Memory

FIGURE: A-9, A-10

Concepts 10: Summarize Types of Storage Media

FIGURES: A-11, A-12

Concepts 12: Differentiate Between Input Devices

FIGURES: A-13, A-14, A-15

Concepts 14: Explain Output Devices

FIGURES: A-16, A-17

Concepts 16: Describe Data Communications

Concepts 18: Define Types of Networks

2. Use an email program to demonstrate sending and receiving a message.

FIGURES: A-20, A-21

Concepts 22: Understand System Software

Concepts 24: Describe Types of Application Software

FIGURES: A-24, A-25

End of Chapter Material

While wire sutures may be used as freely as may be indicated it

Fig. 336 Fig. 337

Pott’s fracture. (Hoffa.) Exaggerated deformity in Pott’s fracture.

FRACTURES OF THE FOOT.

SYMPTOMS AND DIAGNOSIS OF DISLOCATIONS.

PATHOLOGICAL AND CONGENITAL LUXATIONS.

DISLOCATIONS OF THE LOWER JAW.

Fig. 338 Fig. 339

Reduction of dislocation of lower jaw.

DISLOCATIONS OF THE LARYNX.

DISLOCATIONS OF THE STERNUM.

DISLOCATIONS OF THE RIBS.

DISLOCATIONS OF THE CLAVICLE.

Position of clavicle in dislocation of sternal end upward.

Dislocation of both ends, i. e., complete loosening of the bone,

DISLOCATIONS OF THE SHOULDER-JOINT.

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