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2) Patho 2 > 1) ST & Bone Healing > Flashcards

1) ST & Bone Healing Flashcards

1
Q

What are the 5 phases of healing?

A

1) Injury
2) Hemostasis & Degeneration
3) Inflammation
4) Proliferation & Migration
5) Remodeling & Maturation

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2
Q

What happens during the hemostasis & degeneration phases of healing?

A

HEMOSTASIS: Blood vessels seal
Clots form to build fibrin lattice–>These platelets release GF’s to call inflammatory cells to the tissue

DEGENERATION: Hematoma, Necrosis, Inflammatory response

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3
Q

In the hemostatic phase of healing, what do platelets do (besides form the fibrin lattice)?

A

Release GF’s

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4
Q

What is the purpose of the fibrin lattice?

A

Source of tensile strength to the healing wound

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5
Q

What type of responses occur during the inflammation phase of healing?

A

Cellular, Vascular, Humoral, Neurological

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6
Q

What occurs with the vascular response of the inflammation phase?

A

Vasodilation (mediated by histamine, bradykinin, hageman factor, & prostoglandins)

Incr hemoconcentration to incr blood viscosity to slow blood flow from damaged vessels

Edema

Accumulation & adherence of WBC’s to damaged vessels

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7
Q

What occurs with the humoral response of the inflammation phase?

A

Activation of the complement system which stims leukocytes
Incr vascular permeability
Phagocytosis

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8
Q

What occurs with the neurologic response of the inflammation phase?

A

Glucocorticoids are released to regulate WBC fxn

SNS stims hypothalamus to regulate vascular response

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9
Q

What occurs with the cellular response of the inflammation phase?

A

Pathogen is killed & removed
T-cells activate inflammatory mediators
B-cells make antibodies
Macrophages eat

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10
Q

What occurs during the proliferation phase of healing?

A

Neovascularization
Epithelialization
Collagenization

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11
Q

What is the purpose of epithelialization?

A

Provides a barrier to the wound to prevent fluid & electrolyte loss & decr infection risk

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12
Q

What occurs during neovascularization in proliferation?

A

Macrophages stim the release of GF’s
Angiogenesis
Fibroblasts move into unhealthy tissue & proliferate

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13
Q

What is the timeline of collagen during healing?

A

Type 3 collagen is layed down initially

Day 7: There’s a significant amount of collagen, which incr the tensile strength of the wound

Day 12: Type 1 collagen replaces type 3

Day 21: Max collagen production; Strength is 20% of normal

6th wk: Strength is 80% of normal

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14
Q

What occurs during the maturation phase of healing?

A

Collagen Synthesis
Collagen Fiber Orientation
Injury is healed

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15
Q

What day of healing does the maturation phase start on?

A

Day 9

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16
Q

What is the longest phase of healing?

A

Maturation phase

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17
Q

How long does collagen synthesis last for?

A

1-2yrs

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18
Q

What will happen if the basement membrane of the lung is not intact?

A

Fibrosis so decr gas exchange & restrictive lung disease

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19
Q

What direction do gut cells reproduce?

A

Proximal to distal

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20
Q

True or false: Neurons & axons in the CNS & PNS regenerate similarly?

A

True

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21
Q

What occurs as a result of damage to neurons & axons?

A

Glial cells are stimulated to form a fibrous glial scar

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22
Q

In the PNS, where does wallerian degeneration occur in relation to the injury?

A

Distally

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23
Q

Is glial scarring in the PNS an issue?

A

No

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24
Q

Which CN’s have limited to capacity for regeneration?

A

1,2,6, & 9-12

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25
Q

Which CN’s can make a slow, full recovery?

A

2-5, 7

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26
Q

Which CN rarely regenerates?

A

8

27
Q

If the endomysium of a muscle is not intact or the muscle has chronic inflammation, what will happen?

A

Necrosis/Fibrosis

28
Q

What is the purpose of remobilization for muscle strains?

A

Incr fiber regeneration
Improved fiber orientation
Decr scarring

29
Q

After a tendon injury, how long does the maturation phase take?

A

2-16wks

30
Q

After a tendon injury, how long does it take for full tensile strength to be regained?

A

Up to 50wks

31
Q

What is the rehab protocol for a sutured tendon?

A

Rest for inital 3-5days
Gentle PROM on days 4-28
GE AAROM 4th-8th wks
After 8th wk, gradually incr forces

32
Q

What other part of the body do grade 1 sprains heal similarly to?

A

Tendons

33
Q

What limits the healing of grade 2 & 3 sprains & why?

A

Synovium tears bc it limits hematoma formation & GF localization

34
Q

How much weaker is a well-healed ligament?

A

30-50%

35
Q

What enzyme limits ACL healing?

A

Matrix metalloproteinase

36
Q

What is NSAID-use associated w/following injury?

A

Ligament failure

37
Q

How is microfx surgery done & what are the effects

A

Cleans out calcifications & creates tiny fx’s in the subchondral bone

Blood & bone marrow seep out, which creates a clot that releases cartilage-building cells

38
Q

How does healing of the meniscus occur?

A

Via chondrocyte migration

39
Q

What part of the intervertebral disc has minimal healing capacity & why?

A

Sections that are not in direct contact w/vertebral body bc its basically avascular

40
Q

How does synovium heal?

A

Hemmorhage, hypertrophy, & hyperplasia

41
Q

What are the ways fx’s can be classified?

A

Trauma/Stress
Pathological
Displaced/Non-displaced
Open/Closed

42
Q

Types of Fx’s

A 
Transverse
Oblique
Spiral
Comminuted
Segmental
Avulsed
Impacted 
Torus
Greenstick
43
Q

Transverse Fx

A

Fx is at a right angle (perpendicular) to the long axis of the bone

Caused by shear forces

44
Q

Oblique & Spiral Fx’s

A

Fx is at an angle

Result of extreme twisting forces

45
Q

Comminuted Fx

A

Bone breaks into multiple fragments

46
Q

Segmental Fx

A

2 fx lines

47
Q

Avulsed Fx

A

Small piece of bone gets broken off due to an extreme force from tendon/ligament

48
Q

Impacted Fx

A

Bone fragments get driven into each other

49
Q

Torus Fx

A

Bone buckles into itself from axial loading

50
Q

Greenstick Fx

A

Bone gets bent

51
Q

3 Stages of Fx Healing

A

1) Inflammation
2) Repair
3) Remodeling

52
Q

What happens during the inflammation phase of bone healing?

A

Bleeding–>Delivers fibroblasts, platelets, osteoprogenitor cells, cytokines & GF’s

Clotting eventually occurs–>Forms fibrous matrix

53
Q

What happens during the reparative phase of bone healing?

A

Soft callus formation that eventually turns into a hard callus

  • Osteoclasts clear necrotic bone
  • Osteoblasts produce hyaline cartilage
  • Primary bony spicules are formed
54
Q

What GF’s are involved w/the reparative phase of bone healing?

A 
Fibroblast GF
Insulin-like GF
Platelet-derived GF
Transforming GF-8
Vascular Endothelial GF
55
Q

How long does the reparative phase of bone healing last?

A

Wks 2-6/12

56
Q

What happens during the remodeling phase of bone healing?

A
  • Immature bone becomes hard lamellar bone
  • Hard callus gets absorbed by osteoclasts
  • Osteocytes remodel in response to WB
57
Q

How long does the remodeling phase of bone healing last?

A

Until bone is normal strength, so months-years

58
Q

Purpose of bone stimulators

A

Stim Ca2+ uptake & gene expression to incr mineralization

59
Q

Some complications of fx’s

A

Malunion
Delayed Union
Nonunion

60
Q

Malunion

A

Bone doesn’t align properly

61
Q

Delayed Union

A

Fx takes extra long to heal

62
Q

Nonunion

A

Bone doesn’t heal

63
Q

Some risks of fx’s

A 
ST Injury
Infection-->Esp w/open fx
Skin Ulceration
Growth Disturbances from effected growth plates
Post-traumatic arthritis
Adhesions
Arthrodesis
Myositis Ossificans
Osteomyelitis
Re-fx
Neuro complications
Vascular compromise

2) Patho 2 (20 decks)

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