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MSS > 17. Biology of Injury and Healing > Flashcards

17. Biology of Injury and Healing Flashcards

1
Q

What happens in seconds to minutes of soft tissue healing (1)?

A

Bleeding, degeneration and disruption– right after injury

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2
Q

What happens during the ‘bleeding, degeneration, disruption’ stage seconds to minutes after soft tissue injury

A

Prosease are released by myofiber degeneration–auto digestion of damaged tissue and chemotaxsis of neutros and macros.
Vessels injury; expose clot factors and plats to collagen resluting in activation of complement and kinin systems

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3
Q

What happens minutes to hours in soft tissue healing (2)

A

Clot formation; clot of fibrin/plats/RBC serving as scafold for fibroblast repairs

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4
Q

What happens in minutes to day of soft tissue healing (3)

A

Inflammation; protective and intended to eliminate necrotic cells and tissues and initate process of repair

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5
Q

incudes local inflammation response and stimulates release of cytokines (IL-1, 6, 8 and IGF-1) adn other chemotacti factors by T cells

A

Macrophages

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6
Q

What happens in hours to months of soft tissue healing (4)?

A

Repair or regeneration

  1. Proliferation
  2. Tissue repaired by regenration or by fibrosis
  3. scar tissue contraction
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7
Q

What happens during the proliferation phase of repair of soft tissue?

A

Prolif of fibroblasts and migrate to wound–> produce collagen
Phagocytes release enZ to digest exudate/fibrin/debris
Granulation tissue + neovasculizaiton (3-5 dys)
Myofiborblasts contract as tissue matures

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8
Q

Type of tissues that can be repaired by regenration with complete restoration of form and function

A

labile tissues: bone marrow, most surface epithelia, bones

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9
Q

tissues repaired by replacement with CT adn scar formation

A

permanent tissues, skeletal mscls, cartiledge

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10
Q

Scar tissue contraction to ___%
____ weeks can withstand typical stress
_____ months near normal strength

A

80%
2 weeks
3+

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11
Q

What happens in months to years of soft tissue repair (4)

A

remodeling

6 months fibrils more oriented to lines of stress and 1-2 years final remodeling

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12
Q

Stages of Bone healing

A 
Bleeding (seconds-minutes)
Clot formation (minutes-hours)
INflammation (hours-days)
Repair Stage (1-2+ weeks --3+ months)
Remodeling stage (1-2 years)
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13
Q

What happens during the clot formation state in bone healing

A

hematoma formation

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14
Q

What happens in the inflammation stage during bone healing

A

Prostaglandin mediated infiltration of Inflammatory cells (macros/monocytes/lympho/polymorphonuclear/
Proliferation of cells under periosteum and in breached medullary canal
Fibroblasts lay down stroma to support vascular ingrowth (can be inhibited by nicotine)
Granulation tissue formation with vascular ingrowth and mesenchymal cell migration
*Can be ultered by PDG inhibitors (NSAIDS) or cytotoxic meds

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15
Q

1st step in Bone Repair stage (1-2+ weeks- 3+ months)

A

Osteoclasts and blasts invade blood clot

  • -clasts burrow through debris at fracture line
  • -blats fill remaining space
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16
Q

2nd step in Bone repair stage (2-6 weeks)

A

Collagen matrix forms and osteoid, unmineralized and organic portion of bone matrix, is secreated forming a soft callus

17
Q

3rd step in Bone repair stage (4-12+ weeks)

A

Hard callus formed by mineralization of matrix

–union of 4-6 weeks in upper extremity; 8-12 weeks for lower extremity

18
Q

4th step in bone repair stage (12-26 weeks)

A

Consolidation or callus maturation

-woven bone becomes laminar bone

19
Q

5th step in bone repair stage (6-12 months)

A

Bony gap bridged

20
Q

4 Steps in Bone Remodeling stage (1-2 years)

A

Thicker lamellae in response to stress
Resporption of under loaded areas
Medullary reformation
Angular deformities remodel better than rotational deformities

21
Q

Which bone type heals faster: cancellous or cortical

A

cancellous

22
Q

Which fracture type heals faster: spiral or transverse

A

spiral

23
Q

Heals with fibrocartiledge and fibrous tissue which has inferior weight-bearing properties

A

Hyaline cartiledge

24
Q

Occurs with overuse and repetitive stress of growth plate– will usually cause irritation but rarely avulsion of growth plate

A

Apophysitis

25
Q

Common locations of Apophysitis

A

Osgood Schlatter: patellar tendon to tibial tuberacle
SEvers: achilles to calcaneus
Sinding-Larsen-Johansson: patellar tendon origin on inferior patellar pole
The ASIS to sartorius
The AIIS to rectus femoris
Medial epicondyle (little leagers elbow)

26
Q

Tx of apophysitis

A

rest, stretching, ice, and +/- NSAIDs

27
Q

Most common cause of ankle sprain

A

forced ankle inversion

28
Q

Anterior drawer test for ankel sprain

A

abnormal is 3-5mm more than uninjured side; may also feel softer end pt on injured side

29
Q

Squeeze test for ankel sprain
Pain at ankle:
pain at knee:

A

squeeze tibia and fibula together midshaft
Pain at ankle = high ankle sprain
Pain at knee: suspicious for Maisonneuve fx (fx of proximal fibula associated with ankle injury)

30
Q

A positve external rotation test is suspicious for:

A

high ankle sprain

31
Q

Etiology of loose bodes

A

IG trauma or metastatic

32
Q

See swelling or locking; sometimes asymptomatic

A

loose bodies

33
Q

Tx for loose bodies

A

surgical or observation if asymptomatic

34
Q

Best tx for ankle sprain

A

RICE

then Ibuprofen

35
Q

Child came in who inverted ankle, has lateral ankle and mid foot pain. Diffuse tender over anterio talar-fibular ligament and base of 5th metatarsal
Non-tender over postier ankle, negative for squeeze test and external rotation, pain wit resisted eversion:

A

Avulsion at 5th metatarsal base of eroneus brevis insertion

–common in children; tendon in stronger then the bone

36
Q

Positive external rotation

A

high ankle sprain

37
Q

Keys for good ligament healing

A

need good blood supply
needs damaged section to be approximated or guided to correct area
needs rest

38
Q

Of ligaments in knee, which is least likely to heal

A

ACL: has limited vascular supply and there isn’t a soft tissue envelope around the ligament to keep it approximated

39
Q

What is the most important factor for bone repair?

A

Calcium content!!! this is key for bony repair

MSS (26 decks)

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